Disease treatment via developing non-syngeneic graft transplantation

ABSTRACT

A method of providing a pancreatic, lymphoid/hematopietic or pulmonary organ and/or tissue function to a mammalian subject is provided. The method comprises transplanting into the subject a developing mammalian pancreatic, lymphoid/hematopietic or pulmonary organ/tissue graft, respectively, thereby generating a functional pancreatic, lymphoid/hematopietic or pulmonary organ and/or tissue, respectively, for providing the pancreatic, lymphoid/hematopietic or pulmonary organ and/or tissue function, respectively, to the subject.

RELATED APPLICATIONS

This application is a division of U.S. patent application Ser. No.11/664,530 filed on Jul. 30, 2009, which is a National Phase of PCTPatent Application No. PCT/IL2005/001059 having International FilingDate of Oct. 2, 2005, which claims the benefit of priority of IsraelPatent Application No. 165425 filed on Nov. 28, 2004, now abandoned, andU.S. Provisional Patent Application No. 60/614,968 filed on Oct. 4,2004. The contents of the above applications are all incorporated hereinby reference.

U.S. patent application Ser. No. 11/664,530 is also aContinuation-in-Part (CIP) of U.S. patent application Ser. No.11/037,025 filed on Jan. 19, 2005, now U.S. Pat. No. 7,780,993 issued onAug. 24, 2010, which is a Continuation-in-Part (CIP) of U.S. patentapplication Ser. No. 10/759,033 filed on Jan. 20, 2004, now abandoned,which is a Continuation-in-Part (CIP) of U.S. patent application Ser.No. 10/379,725 filed on Mar. 6, 2003, now abandoned.

SEQUENCE LISTING STATEMENT

The ASCII file, entitled 61406SequenceListing.txt, created on Mar. 9,2015, comprising 1,614 bytes, submitted concurrently with the filing ofthis application is incorporated herein by reference.

FIELD AND BACKGROUND OF THE INVENTION

The present invention relates to methods of providingorgan/tissue-specific functions to a subject by transplantation ofdeveloping organs. More particularly, the present invention relates tomethods of treating pancreatic, hematological/metabolic and pulmonarydiseases in mammals by transplantation of developingxenogeneic/allogeneic porcine/human pancreatic, lymphoid/hematopietic orpulmonary organs/tissues, respectively.

Pancreatic diseases such as diabetes, hematological/metabolic diseasessuch as hemophilia A and Gaucher disease, and pulmonary diseases such aslung failure are diseases of great medical and economic impact for whichno satisfactory/optimal treatments are available.

Diabetes is a debilitating and potentially lethal disease that developsin nearly 5 percent of the world's population. In the United Statesalone, an estimated 18 million people have diabetes mellitus, and eachyear about 1 million Americans aged 20 or older are diagnosed with thedisease. It is the sixth leading cause of death in the US and isresponsible for over 200,000 deaths a year. People with diabetes have ashortage of insulin or a reduced ability to use insulin, the hormoneregulates blood glucose levels. In mammals the pancreas is responsiblefor the production and secretion of insulin. The standard therapy fordiabetes, daily injections of insulin, does not satisfactorily preventthe debilitating and lethal consequences of this disease.

Pulmonary failure is a highly debilitating and potentially lethalaffliction which can arise from numerous types of diseases, includingcystic fibrosis, emphysema, pulmonary fibrosis or pulmonaryhypertension. While lung transplantation may be employed as a lastresort for treating such diseases, there is an insufficient supply ofdonor organs, with one quarter of the candidates dying on the waitinglist and the limit for inscription being often set at 60 years of age.Postoperative mortality at two months is about 15 percent and is relatedto graft dysfunction, infection, bronchial complications. Five-yearsurvival is still only about 50 percent.

The genetic defect causing hemophilia A affects about one in every10,000 males. Due to the resultant clotting deficiency, those afflictedwith the disease suffer severe bleeding episodes due to small injuries,internal bleeding, and joint hemorrhage, which leads to arthropathy, themajor cause of morbidity in hemophilia. Normal levels of factor VIIIaverage between 50 to 200 ng/ml of blood plasma (Mannucci, P. M. inPractical Laboratory Hematology, ed. Koepke, J. A., ChurchillLivingstone, N.Y., pp: 347-371, 1990); however, patients suffering frommild to moderate hemophilia A typically have plasma levels well below2-60 ng/ml, while levels below about 2 ng/mL result in severehemophilia.

Treatment of hematological/metabolic diseases such as hemophilia A andGaucher disease is generally effected via enzyme replacement therapy.However, enzyme replacement therapy has numerous significantdisadvantages, including the need to administer the replacement enzymevia injection, a painful, inconvenient, and expensive process. Thediscontinuous dose administration of a replacement enzyme furthermorefails to achieve continuously adjusted physiological levels of theenzyme according to physiological need, as would be achieved by a normalenzyme producing cell population. Thus, enzyme replacement therapy ofhematological/metabolic diseases fails in many cases to achievesatisfactory/optimal disease treatment.

Transplantation of fully differentiated haplotype-matched pancreatic orpulmonary grafts from postgestational stage donors is a life-saving,medical procedure of choice for replacing injured or diseased organssuch as pancreas or lung. Such a treatment modality, however, suffersfrom considerable disadvantages. Allogeneic transplantation ofdifferentiated pancreatic or pulmonary organs/tissues is impossible toimplement in a great many cases due to the unavailability of suitableimmunologically matched transplant donors. Furthermore, use of humandonors to provide organs/tissues for transplantation often presentshealth risks and ethical dilemmas. Thus, large numbers of patients whowould otherwise benefit from therapeutic transplantation succumb todiseases associated with pancreatic or pulmonary failure while awaitingmatched transplant donors. Moreover, even when suitably haplotypematched transplant donors are found, permanent and harmfulimmunosuppressive treatments, such as daily administration ofcyclosporin A, are generally required to prevent graft rejection. Use ofdrugs such as cyclosporin A may be undesirable but the benefit of a lifesaving transplant outweigh the risk of immunosuppressive treatmentImmunosuppressive therapy nevertheless is highly undesirable since thesecause severe side effects such as carcinogenicity, nephrotoxicity andincreased susceptibility to opportunistic infections. Immunosuppressivetreatments contribute to the drawbacks of allogeneic transplantationsince these are often unsuccessful in preventing rejection in the shortterm, and are generally incapable of preventing rejection in the longterm. Acute rejection of transplanted grafts is often fatal.

An alternative to allograft transplantation involves xenografttransplantation, i.e., transplantation of animal-derived grafts, inparticular porcine grafts, which are well established as a potentialanimal alternative to human grafts. The great advantages of usingxenografts for transplantation are their availability on demand to allpatients in need of transplantation, as well as avoidance of the medicaland ethical burden of harvesting grafts from live or cadaveric humandonors. However, to date, xenogeneic organ/tissue grafts have been ruledout for human transplantation due to their heretofore insurmountableimmunological incompatibility with human recipients.

A potentially effective strategy for treating diseases resulting from orassociated with abnormal activity of at least one biomolecule (e.g.,monogenic, hematological, metabolic diseases) such as hemophilia A andGaucher disease would involve non-syngeneic donor transplantation oflymphoid tissues/organs, such as spleen, which are potentially capableof generating therapeutic levels of different gene products such asfactor VIII or glucocerebrosidase which are respectively deficient insuch diseases. As described above, however, the state of the art oftherapeutic transplantation generally remains associated with criticaldisadvantages.

Thus, in view of the unique potential curative benefits oftransplantation therapy, there is clearly an urgent and longstandingneed for non-syngeneic donor-derived pancreatic, pulmonary andlymphoid/hematopietic organs/tissues which can be obtained in sufficientquantities, and which are optimally tolerated immunologically, so as torender feasible the routine and optimally effective therapeutictransplantation of such organs/tissues.

One strategy, which has been proposed to fulfill this aim involves usinggestational stage grafts for transplantation. Such an approach ispromising since it has been shown that immunological tolerance to graftsderived from gestational stage tissue is better than that to graftsderived from adult stage tissues (Dekel B. et al., 1997. Transplantation64, 1550; Dekel B. et al., 1997. Transplantation 64, 1541; Dekel B. etal., 1999. Int Immunol. 11, 1673; Hammerman M R., 2000. Pediatr Nephrol.14, 513). Furthermore, the enhanced growth and differentiation potentialof gestational stage grafts relative to differentiated grafts is highlydesirable for generating optimally functional, host integrated grafts.For example, fetal pancreatic islet cells, such as insulin producingbeta cells, display enhanced cell growth and differentiation relative todifferentiated islet beta cells.

The potential of gestational stage porcine renal (Dekel B. et al., 2003.Nat Med 9:53-60; Hammerman M R., 2004. Am J Transplant. 4 Suppl6:14-24), pancreatic (Korsgren 0. et al., 1991. Diabetologia 34:379-86;Beattie G M. et al., 1997. Diabetes 46:244-8; Fox A. et al., 2002.Xenotransplantation 9:382-92; Korbutt G S. et al., 1996. The Journal ofClinical Investigation 97:2119-29; Amaratunga A. et al., 2003.Xenotransplantation 10:622-7), hepatic (Kokudo N. et al., 1996. CellTransplantation 5:S21-2; Takebe K. et al., 1996. Cell Transplant5:S31-3), neuronal (Larsson L C. et al., 2001. Exp Neurol 172:100-14;Larsson L C. et al., 2003. Transplantation 75:1448-54; Armstrong R J. etal., 2002. Exp Neurol 175:98-111) grafts to generate functionalorgans/tissues following transplantation into non-syngeneic hosts hasbeen extensively described. The potential of gestational stage humanpulmonary (Angioi K. et al., 2002. The Journal of Surgical Research102:85-94), cardiac or intestinal grafts (Angioi K. et al., 2002. TheJournal of Surgical Research 102:85-94; Lim F Y. et al., 2003. Journalof Pediatric Surgery 38:834-9) to generate organs/tissues havingorgan-specific function following transplantation into non-syngeneichosts has also been demonstrated.

Thus, various approaches have been described in the prior art for usingdeveloping pancreatic organ/tissue grafts for therapeutictransplantation.

For example, it has been shown that human fetal islets including theearliest insulin secreting cells, transplanted into nude mice and ratsdisplay continued growth and development, including production of theother pancreatic hormones: glucagon, somatostatin, and pancreaticpolypeptide (Usadel et al., 1980. Diabetes 29 Suppl 1:74-9). Similarly,it has been shown that human embryonic pancreas-derived graftstransplanted into NOD/SCID mice, generated graft-derived insulinproducing human beta-cells (Castaing M. et al., 2001. Diabetologia44:2066). Gestational stage porcine islet transplants in mice maydisplay a similar differentiation program, with similar timing, as thenormal non-transplanted tissues.

Other examples include transplantation of gestational stage porcineislet cells in nude mice (Korsgren O. et al., 1991. Diabetologia34:379-86; Otonkoski T. et al., 1999. Transplantation 68, 1674), offetal pancreas in immunodeficient rodents (Fox A. et al., 2002.Xenotransplantation 9:382-92; Amaratunga A. et al., 2003.Xenotransplantation 10:622-7), of human fetal islets in nude mice andrats (Beattie GM. et al., 1997. Diabetes 46:244-8;) and of porcine fetalislet tissue into nude mice (Korbutt G S. et al., 1996. J Clin Invest.97:2119-29). Another approach involves transplantation of fetal porcineislet-like cell clusters into cynomolgus monkeys (Soderlund J. et al.,1999. Transplantation 67:784-91). Still another approach involvesintratesticular transplantation of neonatal porcine islets intonon-immunosuppressed beagles (Gores P F. et al., 2003. Transplantation75:613-8).

Additionally, attempts to transplant porcine fetal pancreatic tissues indiabetic human recipients have been made (Groth C G. et al., 1998.Transplantation Proceedings 30:3809-10; Groth C G. et al., 1999. J MolMed. 77, 153; Reinholt F P. et al., 1998. Xenotransplantation 5:222-5;Korsgren 0. et al., 1992. Transplantation Proceedings 24:352-3; Groth CG. et al., 1994. Lancet 344:1402-4).

US 2003/0198628 to Hammerman discloses a method for pancreastransplantation comprising implanting into a host an embryonic pancreas.In one embodiment the pancreas is harvested from a porcine embryo fromabout day E20 to about day E38, the most preferred harvest day beingabout day E29.

US Patent Application Nos. 20040082064 and 20040136972 to some of theinventors of the present application suggest treating pancreatic diseasein humans by transplantation of porcine pancreatic organ/tissue graftsat a developmental stage of 20-28 days of gestation, and teach that27-28 days of gestation is the optimal gestational stage of any type ofporcine organ/tissue grafts for therapeutic transplantation.

Various prior art approaches have been described in the prior art forusing developing pulmonary organ/tissue grafts for therapeutictransplantation.

In one approach, human pulmonary grafts at a gestational stage of 6-10weeks were transplanted into immunodeficient mice (Angioi K. et al.,2002. The Journal of Surgical Research 102:85-94).

In another approach, lung fragments from human fetuses at 10 to 14 weeksof gestation were transplanted into immunodeficient mice (Groscurth P,Tondury G., 1982. Anat Embryol (Berl). 165:291-302).

Regarding transplantation of lymphoid/hematopietic organ/tissue grafts,US Patent Publication No. 20040136972 to some of the inventors of thepresent application asserts that all types of porcine organ/tissuegrafts at a developmental stage of 27-28 days, specifically includingsplenic organ/tissue grafts, are optimal for therapeutictransplantation.

However, all previous approaches involving transplantation of developingnon-syngeneic pancreatic, pulmonary or lymphoid/hematopieticorgans/tissues suffer from some or all of the following drawbacks:

(i) suboptimal tolerance by non-syngeneic host lymphocytes;

(ii) suboptimal structural and functional graft differentiation, forexample with respect to insulin production by pancreatic organ/tissuegrafts;

(iii) predominantly graft-derived, as opposed to host-derived, graftvascularization, thereby leading to immune rejection;

(iv) suboptimal growth;

(v) inadequate availability of transplantable organs/tissues; and/or

(vi) suboptimal safety for human administration, notably with respect toavoidance of generation of graft-derived teratomas.

Previous approaches employing developing non-syngeneic grafts have beenuniformly suboptimal since the optimal gestation time for implantationbased on risk for teratoma, growth potential and immunogenicity, all ofwhich might vary between different organs in fetal development, was notsufficiently characterized.

There is thus a widely recognized need for, and it would be highlyadvantageous to have, a method of treating human diseases amenable totherapeutic transplantation by transplantation of developingnon-syngeneic pancreatic, pulmonary or lymphoid/hematopieticorgans/tissues devoid of the above limitations.

SUMMARY OF THE INVENTION

The present invention discloses the use of non-syngeneic developingpancreatic, lymphoid and pulmonary grafts for disease treatment. Thisuse can be effected in a variety of ways as further described andexemplified hereinbelow.

The present invention is based on the unexpected discovery of suitabletime windows for successful transplantation of non-syngeneic developingpancreatic, pulmonary or lymphoid/hematopietic organs/tissues. It ispresently disclosed for the first time that non-syngeneic pancreaticorgan/tissue grafts, such as xenogeneic porcine grafts, at adevelopmental stage essentially corresponding to that of porcinepancreas at a gestational stage of 42 to 56 days of gestation areoptimal for growth and development of insulin-producing pancreaticorgans/tissues. It is further presently further disclosed for the firsttime that lymphoid/hematopietic organ/tissue grafts, such as xenogeneicporcine lymphoid/hematopietic organ/tissue grafts, at a developmentalstage essentially corresponding to that of porcine spleen at agestational stage of 42 to 56 days of gestation are optimal for growthand development of factor VIII-producing pancreatic organs/tissues, andcan be used to treat hemophilia A in a mammal. It is yet furtherpresently disclosed for the first time that non-syngeneic pulmonarygrafts at a developmental stage essentially corresponding to that ofporcine lung at a gestational stage of 56 to 80 days are optimal forgrowth and differentiation of pulmonary organs/tissues which comprisealveoli.

According to one aspect of the present invention there is provided amethod of providing a pancreatic function to a mammalian.

According to still further features in the described preferredembodiments, the pancreatic organ/tissue graft is at a developmentalstage essentially corresponding to that of a porcine pancreaticorgan/tissue at a gestational stage selected from a range of about 42 toabout 80 days of gestation, thereby generating a functional pancreaticorgan/tissue for providing the pancreatic function to the subject.

According to further features in preferred embodiments of the inventiondescribed below, the pancreatic organ/tissue graft is at a developmentalstage essentially corresponding to that of a porcine pancreaticorgan/tissue at a gestational stage selected from a range of about 42 toabout 56 days of gestation.

According to further features in preferred embodiments of the inventiondescribed below, the pancreatic organ/tissue graft is at a developmentalstage essentially corresponding to that of a porcine pancreaticorgan/tissue at a gestational stage of about 42 days of gestation.

According to still further features in the described preferredembodiments, the pancreatic organ/tissue graft is non-syngeneic with thesubject.

According to still further features in the described preferredembodiments, the pancreatic organ/tissue graft is xenogeneic with thesubject.

According to still further features in the described preferredembodiments, the pancreatic organ/tissue graft is of porcine origin.

According to still further features in the described preferredembodiments, the subject has an abnormal activity a biomoleculenaturally produced by a mammalian pancreas.

According to still further features in the described preferredembodiments, the subject has an abnormal activity a biomoleculenaturally produced by a mammalian pancreatic islet.

According to still further features in the described preferredembodiments, the biomolecule is insulin.

According to another aspect of the present invention there is provided amethod of providing a pancreatic function to a mammalian subject, themethod comprising transplanting into the subject a mammalian pancreaticorgan/tissue graft, wherein the pancreatic organ/tissue graft is at adevelopmental stage essentially corresponding to that of a humanpancreatic organ/tissue at a gestational stage selected from a range ofabout 14 to about 20 weeks of gestation, thereby generating a functionalpancreatic organ/tissue for providing the pancreatic function to thesubject.

According to yet another aspect of the present invention there isprovided a method of generating pulmonary tissue in a mammalian subjectin need thereof, the method comprising transplanting into the subject adeveloping mammalian pulmonary graft, wherein the pulmonary graft is ata developmental stage essentially corresponding to that of a porcinepulmonary organ/tissue at a gestational stage selected from a range ofabout 42 to about 80 days of gestation, thereby generating pulmonarytissue in the subject.

According to further features in preferred embodiments of the inventiondescribed below, the pulmonary graft is at a developmental stageessentially corresponding to that of a porcine pulmonary organ/tissue ata gestational stage selected from a range of about 56 to about 80 daysof gestation.

According to still further features in the described preferredembodiments, the pulmonary graft is non-syngeneic with the subject.

According to still further features in the described preferredembodiments, the pulmonary graft is xenogeneic with the subject.

According to still further features in the described preferredembodiments, the pulmonary organ/tissue graft is of porcine origin.

According to still another aspect of the present invention there isprovided a method of treating a hemophilia in a mammalian subject inneed thereof, the method comprising transplanting into the subject adeveloping mammalian lymphoid/hematopietic organ/tissue graft, whereinthe lymphoid/hematopietic organ/tissue graft is at a developmental stageessentially corresponding to that of a porcine lymphoid/hematopieticorgan/tissue at a gestational stage selected from a range of about 42 toabout 80 days of gestation, thereby generating a functionallymphoid/hematopietic organ/tissue for treating the hemophilia in thesubject.

According to further features in preferred embodiments of the inventiondescribed below, the hemophilia is hemophilia A.

According to still another aspect of the present invention there isprovided a method of providing a lymphoid/hematopietic organ/tissuefunction to a human subject, the method comprising transplanting intothe subject a developing mammalian lymphoid/hematopietic organ/tissuegraft, preferably the lymphoid/hematopietic organ/tissue graft is at adevelopmental stage essentially corresponding to that of a porcinelymphoid/hematopietic organ/tissue at a gestational stage selected froma range of about 42 to about 80 days of gestation, thereby generating afunctional lymphoid/hematopietic organ/tissue for providing thelymphoid/hematopietic organ/tissue function to the subject.

According to further features in preferred embodiments of the inventiondescribed below, the lymphoid/hematopietic organ/tissue graft is at adevelopmental stage at which a lymphoid/hematopietic organ/tissueessentially does not comprise T-cells.

According to still further features in the described preferredembodiments, the lymphoid/hematopietic organ/tissue graft is at adevelopmental stage essentially corresponding to that of a porcinelymphoid/hematopietic organ/tissue at a gestational stage selected froma range of about 42 to about 56 days of gestation.

According to still further features in the described preferredembodiments, the lymphoid/hematopietic organ/tissue graft is at adevelopmental stage essentially corresponding to that of a porcinelymphoid/hematopietic organ/tissue at a gestational stage of about 42days of gestation.

According to still further features in the described preferredembodiments, the lymphoid/hematopietic organ/tissue graft isnon-syngeneic with the subject.

According to still further features in the described preferredembodiments, the lymphoid/hematopietic organ/tissue graft is xenogeneicwith the subject.

According to still further features in the described preferredembodiments, the lymphoid/hematopietic organ/tissue graft is of porcineorigin.

According to still further features in the described preferredembodiments, the subject is human.

According to still further features in the described preferredembodiments, subject has an abnormal activity of a biomolecule naturallyproduced by a lymphoid/hematopoietic organ/tissue thereof.

According to still further features in the described preferredembodiments, the subject has an abnormal serum concentration of abiomolecule produced by a mammalian liver or lymphoid/hematopieticorgan/tissue.

According to still further features in the described preferredembodiments, the subject has an abnormal serum concentration of aclotting cascade factor produced by a mammalian lymphoid/hematopieticorgan/tissue.

According to still further features in the described preferredembodiments, the lymphoid/hematopietic organ/tissue graft is derivedfrom a developing lymphoid/hematopietic organ/tissue.

According to still further features in the described preferredembodiments, the lymphoid/hematopietic organ/tissue graft is derivedfrom fetal spleen.

According to still further features in the described preferredembodiments, the method further comprising transiently administering tothe subject at least one T-cell costimulation inhibitor and at least oneCD40 ligand inhibitor.

According to still further features in the described preferredembodiments, transplanting the graft into the subject is effected bytransplanting the graft under at least one renal capsule of the subject.

The present invention successfully addresses the shortcomings of thepresently known configurations by providing new developing/non-syngeneicpancreatic, lymphoid/hematopietic or pulmonary organ/tissue grafts whichare at stages of development enabling effective/optimal treatment in arecipient thereof of essentially any disease which is amenable totherapeutic transplantation of pancreatic, lymphoid/hematopietic orpulmonary organ/tissue grafts, respectively.

Unless otherwise defined, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although methods and materialssimilar or equivalent to those described herein can be used in thepractice or testing of the present invention, suitable methods andmaterials are described below. All publications, patent applications,patents, and other references mentioned herein are incorporated byreference in their entirety. In case of conflict, the patentspecification, including definitions, will control. In addition, thematerials, methods, and examples are illustrative only and not intendedto be limiting.

BRIEF DESCRIPTION OF THE DRAWINGS

The patent or application file contains at least one drawing executed incolor. Copies of this patent or patent application publication withcolor drawings will be provided by the Office upon request and paymentof the necessary fee.

The invention is herein described, by way of example only, withreference to the accompanying drawings. With specific reference now tothe drawings in detail, it is stressed that the particulars shown are byway of example and for purposes of illustrative discussion of thepreferred embodiments of the present invention only, and are presentedin the cause of providing what is believed to be the most useful andreadily understood description of the principles and conceptual aspectsof the invention. In this regard, no attempt is made to show structuraldetails of the invention in more detail than is necessary for afundamental understanding of the invention, the description taken withthe drawings making apparent to those skilled in the art how the severalforms of the invention may be embodied in practice.

In the drawings:

FIGS. 1 a-f are photomicrographs depicting histological staining of anE42 porcine pancreas graft 6 weeks after transplantation. H&E staining(FIG. 1 a), cytokeratin 20 (FIG. 1 b), vimentin (v9) (FIG. 1 c),anti-mouse CD31 (FIG. 1 d), insulin (FIG. 1 e), Ki67 (FIG. 1 f).

FIGS. 2 a-2 e are photographs depicting an E56 pancreatic organ/tissuegraft 3 months posttransplantation. Shown are the graft and itsvasculature (FIG. 2 a), H&E staining (FIG. 2 b), insulinimmunohistochemical staining (FIG. 2 c), pancreatic polypeptideimmunohistological staining (FIG. 2 d), and Ki67 immunohistologicalstaining (FIG. 2 e).

FIG. 3 is a cumulative data plot depicting porcine insulin levels inserum of SCID mice following transplantation of porcine embryonicpancreas. Donor tissue obtained at different gestational ages wasimplanted under the kidney capsule and serum levels were documented 6weeks after transplantation as determined by ELISA.

FIGS. 4 a-d are photomicrographs depicting immunohistological stainingof porcine endothelial cells (lining along blood vessels) marked byCD-31 positive staining (darker staining) in embryonic pancreas at E24,E27, E35 and E42, respectively.

FIGS. 5 a-d are graphs depicting the long-term follow-up of porcineinsulin levels detected in the serum of NOD-SCID mice following fetalpancreas transplantation from donors of different gestational ages.FIGS. 5 a-d respectively depict the insulin levels produced by organsgenerated from gestational day E28, E35, E42 and E56 porcine pancreasgraft donors.

FIG. 6 is a graph depicting the glucose levels in alloxan treatedNOD-SCID mice, without a graft (solid lines) and 4 and 10 daysposttransplantation of an E42 fetal porcine pancreas graft.

FIGS. 7 a-d are histology photomicrographs depicting the level ofrejection of porcine embryonic pancreatic tissues (E56 and E80) mediatedby human PBMCs, 6 weeks after transplantation under the kidney capsuleof NOD-SCID mice. FIG. 7 a depicts H&E staining of E56 pig pancreatictissue. FIG. 7 b depicts local infiltration of human PBMCs in the E56graft stained with anti-human CD45. FIG. 7 c depicts H&E staining of E80pancreatic organ/tissue graft. FIG. 7 d depicts human PBMCs stained withanti-human CD45 antibody invading the E80 pancreatic organ/tissue graft.

FIGS. 8 a-c are photomicrographs depicting histological sections ofpancreas tissue (E42) transplanted into immunodeficient andimmunocompetent mice. FIG. 8 a shows the tissue in a NOD-SCID mouse,FIG. 8 b shows the tissue in a C57BL/6 mouse, and FIG. 8 c shows thetissue is an immunosuppressed C57BL/6 mouse.

FIGS. 9 a-e are photographs depicting development of E56 and E80 porcinelung 6 weeks following implantation under the kidney capsule. FIG. 9 adepicting growth of transplanted tissue obtained at E56 ismacroscopically illustrated. FIG. 9 b depicts stained lung tissue (H&E):respiratory bronchi (arrow), bronchioles (asterisks) and alveoli (arrowheads). FIG. 9 c depicts alcian-blue/PAS stained cartilage of E56 lungimplants. FIGS. 9 d-e depict H&E staining of alveolar wall structure andthickness of E56 and E80 implants, respectively.

FIGS. 10 a-b depict immunochemical staining with H&E and anti-vimentin(v9), respectively, of E42 transplanted porcine splenic tissue 6 weeksafter transplantation.

FIG. 11 shows the relative amounts of porcine factor VIII mRNA indifferent splenic tissues before and after transplantation. Factor VIIIlevels were evaluated by real-time PCR using primers specific forporcine factor VIII. The results were divided by the expression of thehouse-keeping gene beta-actin using primers specific for the porcineBeta-actin. Total mRNA that was purified either from adult tissue orfrom E80 or E100 precursor tissue from porcine liver and porcine spleenserved as positive control. Total mRNA that was purified from the mousekidney, from an area distant from the embryonic implant, served asnegative control.

FIGS. 12 a-e depict immunohistological staining of pig CD3+ T cells inembryonic pig precursor spleen tissue harvested at E42, E56, E80, E100and from adult spleen, respectively.

FIGS. 13 a-d are photographs depicting development of E42 pig spleenfollowing implantation under the kidney capsule of NOD-SCID mice. FIG.13 shows E42 macro view. FIG. 13 b shows pig mesenchymal components(brown) specifically stained with vimentin (V9). FIG. 13 c shows porcineblood vessels, as shown by pig CD31 expression, and proliferativeability is demonstrated by ki67 staining in FIG. 13 d.

FIG. 14 is a series of photomicrographs depicting development ofhematopoietic nests and fibrous septae in pig E42 spleen implants. At 2months, a sponge-like fibrous reticular network outlined by anti-lamininantibody (brown) with diffusely entrapped mouse erythroid cells stainedby anti-mouse TER 119 (brown) is evident. In contrast, at 3 monthsposttransplant, dense laminin-positive connective tissue septa isevident, surrounding nests of mouse hematopoietic tissue, includingTER-119-positive erythropoietic areas and regions with megakaryocytes(arrow) and myelopoiesis. Host myeloid cells, demonstrated by mouseMAC-1 immunostaining (brown) are rare and diffusely distributed inspleen transplants at 2 months, but become numerous within hematopoieticnests at 3 months following transplant.

FIG. 15 is a bar-graph depicting the relative amount of pig factor VIIImRNA in different transplanted tissues, as evaluated by RT-PCR using pigfactor VIII specific primers. The results were normalized to theexpression of the housekeeping gene, transferrin receptor. Pig factorVIII levels in E28, E42 and E56 spleen grafts are shown by orange, greenand red columns, respectively. Adult, E100, and E80 spleen precursortissues prior to transplantation are shown by blue, yellow and purplecolumns. Total mRNA purified from adult pig spleen (blue column) servedas positive control. Total mRNA purified form the mouse kidney, from anarea distant from the embryonic implant and from an E28 pancreas graftserved as negative controls.

FIG. 16 is a bar-graph depicting PTT values of wild type NOD-SCIDcontrol mice, factor VIII KO-SCID control mice and factor VIII KO-SCIDmice transplanted with E42 pig spleen, 2, 5, 12 and 14 weeks aftertransplantation. ****P value=0.0001 (compared to factor VIII KO-SCID).

FIGS. 17 a-b are bar-graphs depicting chromogenic determination offactor VIII activity in plasma of transplanted mice. FIG. 17 a depictscomparison of factor VIII KO-SCID control mice (yellow), wild typeNOD-SCID control mice (red) and factor VIII KO-SCID mice transplantedwith E42 pig spleen 8 weeks (purple) and 14 weeks (blue) aftertransplantation. FIG. 17 b depicts distribution of factor VIII levelsdetermined by chromogenic assay in individual factor VIII KO-SCID mice,14 weeks after transplantation of E42 pig spleen precursor tissue.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention is of methods of providing pancreatic,lymphoid/hematopoietic or pulmonary organ and/or tissue functions to amammalian subject by transplantation of developing organ/tissue grafts.These methods can respectively be used to effectively treat viatherapeutic transplantation human patients suffering from pancreaticdiseases such as type I diabetes, hematological/metabolic diseases suchas hemophilia and Gaucher disease, or pulmonary failure. The presentinvention employs transplantation of novel organ/tissue-specific graftswhich are at developmental stages at which these grafts have thecapacity to generate in graft recipients organs/tissues displaying anoptimal combination of structural and functional differentiation,growth, immune acceptance in the case of non-syngeneic grafts, and lowrisk of teratoma formation.

The principles and operation of the present invention may be betterunderstood with reference to the drawings and accompanying descriptions.

Before explaining at least one embodiment of the invention in detail, itis to be understood that the invention is not limited in its applicationto the details set forth in the following description or exemplified bythe Examples. The invention is capable of other embodiments or of beingpracticed or carried out in various ways. Also, it is to be understoodthat the phraseology and terminology employed herein is for the purposeof description and should not be regarded as limiting.

Organ or tissue transplantation is the optimal or sole therapy fornumerous highly debilitating/lethal pancreatic, pulmonary andhematological/metabolic diseases. However, current methods oftherapeutic transplantation are severely hampered by inadequate sourcesof immunologically and/or morphologically compatible donororgans/tissues, and by the permanent requirement for highly intensiveand harmful immunosuppressive treatment of graft recipients to preventgraft rejection. Strategies suggested for overcoming these obstaclesinvolve using developing/non-syngeneic organ/tissue grafts, such asdeveloping pig or human grafts—such grafts being potentially availablein sufficient quantities, and having been shown to be better toleratedby mismatched recipients than fully differentiated organ/tissue graftsby virtue of being derived from gestational stage donors.

However, all previous approaches involving transplantation ofdeveloping/non-syngeneic pancreatic, pulmonary or lymphoid/hematopieticorgans/tissues suffer from significant disadvantages, including:suboptimal tolerance by non-syngeneic host lymphocytes; suboptimalstructural and functional graft differentiation, for example withrespect to insulin production by pancreatic organ/tissue grafts;predominantly graft-derived, as opposed to host-derived, graftvascularization, thereby leading to immune rejection; suboptimal growth;inadequate availability of transplantable organs/tissues; and/orsuboptimal safety for human administration, notably with respect toavoidance of generation of graft-derived teratomas.

Previous approaches employing developing non-syngeneic grafts have beenuniformly suboptimal since the optimal gestation time for implantationbased on risk for teratoma, growth potential and immunogenicity, all ofwhich might vary between different organs in fetal development, was notsufficiently characterized. Moreover, the prior art fails to teach anymethod of practicing therapeutic transplantation of developingnon-syngeneic lymphoid organ/tissue grafts.

While reducing the present invention to practice, the present inventorshave uncovered specific developmental stages of non-syngeneicpancreatic, pulmonary and lymphoid/hematopietic organ/tissue graftsduring which these can be transplanted into a recipient so as togenerate, in the absence of graft-derived teratomas, cells, organs andtissues which display optimal growth, structural and functionaldifferentiation and requirement for minimal recipient immunosuppression.

Specifically, while reducing the present invention to practice, thefollowing were uncovered: pancreatic xenografts derived from pigs at adevelopmental stage of 42 to 80 days of gestation (e.g., 42-56 days ofgestation), or human pancreatic organ/tissue allografts at adevelopmental stage of 14-20 weeks, can be used to generate followingtransplantation well-developed insulin-producing pancreaticorgans/tissues; pulmonary organ/tissue xenografts from pigs at agestational stage of 42 to 80 days of gestation can generate followingtransplantation well developed pulmonary organs/tissues includingalveolar structures; and lymphoid/hematopietic organ/tissue xenograftsfrom pigs at a gestational stage of 42 to 80 days can generate welldeveloped lymphoid/hematopietic organs/tissues followingtransplantation. In particular, lymphoid/hematopietic organ/tissuexenografts from pigs at a gestational stage of 42 days were used togenerate well developed lymphoid/hematopietic organs/tissues whichsecrete therapeutic levels of factor VIII following transplantation intofactor VIII-deficient mammals.

As shown hereinbelow and in the Examples section which follows,therapeutic grafts of the present invention are harvested at a specificdevelopmental window which impart these grafts with functionality andendurance characteristics which are superior to the grafts provided bythe prior art. Thus, as is shown in the Examples which follow,pancreatic porcine grafts harvested at E42-56 are superior to prior artporcine grafts harvested at E28 (US Patent Publication No. 20040136972)or E80 [Groth C G. et al., (1994) Lancet 344:1402-4]. Similarly, porcineembryonic spleen harvested at E42 are supperio to tissue harvested atE28 and E80.

The present invention is based on the unexpected discovery of distinctgestational time windows optimal for therapeutic transplantation ofdevelopmental stage pancreatic, pulmonary or lymphoid/hematopieticorgans/tissues. There are three major criteria for selectingdeveloping/non-syngeneic grafts for therapeutic transplantation: (i) thegraft should be at a sufficiently advanced developmental stage so as tobe capable of generating a structurally and functionally differentiated,host vascularized organ/tissue in-situ; (ii) the graft should be at asufficiently advanced developmental stage so as not to inducegraft-derived teratomas; and (iii) the graft should be at a sufficientlyearly developmental stage so as to be optimally toleratedimmunologically by non-syngeneic human lymphocytes. Often there is atradeoff between the three criteria, with functionality of the tissueorgan being the most urgent.

Thus, according to one aspect of the present invention, there isprovided a method of providing a pancreatic function to a mammaliansubject. The method is effected by transplanting into the subject amammalian pancreatic organ/tissue graft, which is at a developmentalstage essentially corresponding to that of a porcine pancreaticorgan/tissue at a gestational stage of about 42 to about 80 days ofgestation.

As used herein the term “about” refers to plus or minus 10 percent.

The method according to aspects of the present invention relating totransplantation of pancreatic organ/tissue grafts can be used fortreating any disease in the subject which is amenable to treatment viatransplantation of a pancreatic organ/tissue graft.

As used herein, the term “treating” includes curing, alleviating, orstabilizing the disease, or inhibiting future onset or development ofthe disease.

As used herein, the term “disease” refers to any disease, disorder,condition or to any pathological or undesired condition, state, orsyndrome, or to any physical, morphological or physiologicalabnormality.

Diseases of the present invention are typically resulting or areassociated with abnormal activity of at least one biomolecule naturallyproduced by the subject. Such an abnormal activity of the biomoleculemay result from abnormal synthesis or degradation of the biomolecule.Alternatively, it may result from abnormal catalytic activity (i.e.,increased or decreased as compared to an activity produced by a healthytissue).

The subject according to various aspects of the present invention ispreferably a human.

Preferably, the pancreatic organ/tissue graft which is at adevelopmental stage essentially corresponding to that of a porcinepancreatic organ/tissue at a gestational stage of about 28-80 ofgestation, preferably of about 42 to about 56 days of gestation.

While such a graft may originate from any of various donor mammals, asdescribed further hereinbelow, such a graft is preferably non-syngeneicwith the subject and/or is derived from a pig, most preferably both ofwhich. Alternately, such a pancreatic organ/tissue graft may besyngeneic with the subject and/or derived from a human.

As used herein, the term “non-syngeneic” graft refers to a graft whichis not essentially genetically identical with the subject or essentiallyall lymphocytes of the subject, such as an allogeneic graft or axenogeneic graft.

As used herein, the term “allogeneic graft” refers to a graft which isderived from a donor which is non-syngeneic with the subject or with asubstantial proportion of the lymphocytes present in the subject, andwhich is of the same species as the subject or substantially all of thelymphocytes of the subject. Typically, non-clonal/non-twin mammals ofthe same species are allogeneic relative to each other.

As used herein, the term “xenogeneic graft” refers to a graft which isderived from a donor that is of a different species than the subject orof a substantial proportion of the lymphocytes present in the subject.

As used herein, the term “syngeneic graft” refers to a graft which isessentially genetically identical with the subject or essentially alllymphocytes of the subject. Examples of syngeneic grafts include a graftderived from the subject (also referred to in the art as an “autologousgraft”), from a clone of the subject, or from an identical twin of thesubject.

Thus, according to another aspect of the present invention, there isprovided a method of providing a pancreatic function to a mammaliansubject. The method is effected by transplanting into the subject apancreatic organ/tissue graft which is at a developmental stageessentially corresponding to that of a human pancreatic organ/tissue ata gestational stage of about 14 to about 20 weeks of gestation.

Preferably, the pancreatic organ/tissue graft which is at adevelopmental stage essentially corresponding to that of a humanpancreatic organ/tissue at a gestational stage of about 14 to about 20weeks of gestation.

While such a graft may originate from any of various donor mammals, asdescribed further hereinbelow, such a graft is preferably of human fetalorigin and/or is non-syngeneic with the subject. Alternately, such apancreatic organ/tissue graft may be derived from a pig. The graft maybe syngeneic with the subject.

Transplantation of a pancreatic organ/tissue graft of the presentinvention is preferably used to provide pancreatic function to a subjecthaving an abnormal serum concentration of a biomolecule produced by amammalian pancreas, more preferably where the serum concentration isabnormally low. Preferably the biomolecule is produced by mammalianpancreatic islets, and is most preferably insulin.

As is described and illustrated in Example 6 of the Examples sectionbelow, a pig pancreatic organ/tissue xenograft at a developmental stageof 42 to 56 days can be used to generate, in the absence of teratomaformation, well developed pancreatic organs/tissues producing optimallevels of insulin in a recipient thereof, and hence can be used fortreatment of a pancreatic disease such as type 1 diabetes(insulin-dependent diabetes mellitus, and juvenile onset diabetes).

It will be appreciated that the present disclosure that a mammalianpancreatic organ/tissue graft which is at such a developmental stage canbe used to generate well developed insulin-secreting pancreaticorgans/tissues suitable for treatment of a pancreatic disease, such astype 1 diabetes, is clearly novel and unpredictable relative to theprior art.

As is further shown and illustrated in Example 5 of the Examples sectionbelow, a pancreatic organ/tissue allograft of human origin at adevelopmental stage of 8 weeks can be used to generate, in the absenceof teratoma formation, well developed pancreatic organs/tissuesproducing optimal levels of insulin in a recipient thereof, and hencecan be used for treatment of a pancreatic disease such as type 1diabetes.

It will be appreciated that the present disclosure that a mammalianpancreatic organ/tissue graft which is at such a developmental stage canbe used to generate well developed insulin-secreting pancreaticorgans/tissues suitable for treatment of a pancreatic disease, such astype 1 diabetes, is clearly novel and unpredictable relative to theprior art.

Alternately, examples of diseases which can be treated via aspects ofthe present invention relating to transplantation of a pancreaticorgan/tissue graft include type 2 diabetes and pancreatic cancer.

Thus, according to a further aspect of the present invention, there isprovided a method of generating pulmonary tissue in a mammalian subjectin need thereof. The method is effected by transplanting into thesubject a developing mammalian pulmonary graft which is at adevelopmental stage essentially corresponding to that of a porcinepulmonary organ/tissue at a gestational stage of about 42 to about 80days of gestation.

The method according to this aspect of the present invention can be usedfor treating any disease in the subject which is amenable to treatmentvia transplantation of a pulmonary organ/tissue graft.

Preferably, the pulmonary graft is at a developmental stage essentiallycorresponding to that of a porcine pulmonary organ/tissue at agestational stage of about 56 to about 80 days of gestation.

While such a graft may originate from any of various donor mammals, asdescribed further hereinbelow, such a graft is preferably of porcineorigin and/or is non-syngeneic with the subject, most preferably both ofwhich. Alternately, the lymphoid/hematopietic organ/tissue graft may besyngeneic with the subject and/or derived from a human.

As is described and illustrated in Example 7 of the Examples sectionbelow, a pulmonary organ/tissue xenograft of porcine origin at adevelopmental stage of 56 to 80 days can be used to generate, in theabsence of teratoma formation, well developed pulmonary organs/tissueswhich comprise alveolar structures. Hence, such pulmonary organ/tissuegrafts can be used for therapeutic transplantation for treatment ofpulmonary failure.

It will be appreciated that the present disclosure that a mammalianpulmonary organ/tissue graft which is at such a developmental stage canprovide pulmonary organs/tissues to a recipient thereof is clearly noveland unpredictable relative to the prior art.

Examples of pulmonary diseases which can be treated according to thisaspect of the present invention include cystic fibrosis, emphysema,asbestosis, chronic obstructive pulmonary disease (COPD) and pulmonaryfibrosis.

Thus, according to a still further aspect of the present invention,there is provided a method of providing a lymphoid/hematopieticorgan/tissue function to a mammalian subject.

The method is effected by transplanting into the subject a developingmammalian lymphoid/hematopietic organ/tissue graft.

The method according to this aspect of the present invention can be usedfor treating any disease in the subject which is amenable to treatmentvia transplantation of a lymphoid/hematopietic organ/tissue graft. Inparticular, the method according to this aspect of the present inventioncan be used to treat hemophilia, in particular hemophila A.

Preferably, the lymphoid/hematopietic organ/tissue graft is at adevelopmental stage at which a lymphoid/hematopietic organ/tissueessentially does not comprise T-cells.

Without being bound to a paradigm, the present inventors are of theopinion that a lymphoid/hematopietic organ/tissue graft at such adevelopmental stage will have minimal risk of inducing graft-versus-hostdisease (GVHD) in a recipient thereof by virtue of lacking T-cells.

Preferably, the lymphoid/hematopietic organ/tissue graft is at adevelopmental stage essentially corresponding to that of a porcinelymphoid/hematopietic organ/tissue at a gestational stage of about 42 toabout 80 days of gestation, more preferably at a developmental stageessentially corresponding to that of a porcine lymphoid/hematopieticorgan/tissue at a gestational stage of about 42 to about 56 days ofgestation, and most preferably, at a developmental stage essentiallycorresponding to that of a porcine lymphoid/hematopietic organ/tissue ata gestational stage of about 42 days of gestation.

The lymphoid/hematopietic organ/tissue graft is capable of producinglymphocytes and/or hematopoietic cells. The lymphoid/hematopieticorgan/tissue preferably derived from spleen. Alternately, thelymphoid/hematopietic organ/tissue graft may be derived from lymph node,Peyer's patches thymus or bone marrow.

While such a graft may originate from any of various donor mammals, asdescribed further hereinbelow, such a graft is preferably of porcineorigin and/or is non-syngeneic with the subject, most preferably both ofwhich. Alternately, the lymphoid/hematopietic organ/tissue graft may besyngeneic with the subject and/or derived from a human.

Transplantation of a lymphoid/hematopietic organ/tissue graft of thepresent invention is preferably used to provide lymphoid/hematopieticorgan/tissue function to a subject having an abnormal activity of abiomolecule naturally produced by a mammalian lymphoid/hematopieticorgan/tissue.

Preferably, the biomolecule is a clotting cascade factor, morepreferably factor VIII.

As is shown and illustrated in Example 10 of the Examples section below,a lymphoid/hematopietic organ/tissue xenograft of porcine origin at adevelopmental stage of 42 days of gestation can be used to generate, inthe absence of teratoma formation, well developed lymphoid/hematopieticorgans/tissues producing therapeutic levels of a hematological enzyme,such as factor VIII, where the subject has a disease involving adeficiency of such an enzyme, and hence can be used for treatment of asubject having a hematological/metabolic disease such as a hemophilia,in particular hemophilia A.

It will be appreciated that the present disclosure that a mammalianlymphoid/hematopietic organ/tissue graft which is at such adevelopmental stage can be used to generate lymphoid/hematopieticorgans/tissues capable of generating therapeutic levels of factor VIIIin a factor VIII-deficient mammal is clearly novel and unpredictablerelative to the prior art.

Other examples of diseases associated with clotting factor deficiencywhich can be treated according to this aspect of the present inventioninclude hemophilia B/factor IX deficiency and von Willebrand'sdisease/von Willebrand factor deficiency. The method according to thisaspect of the present invention can be used to treat any of varioushematological lysosomal storage diseases, including Gaucher disease(glucocerebrosidase deficiency). It will be appreciated that the methodaccording to this aspect of the present invention can also be used torepair splenic injury.

Depending on the transplantation context, in order to facilitateengraftment of a non-syngeneic graft of the present inventiontransplanting a graft of the present invention may furtheradvantageously comprise treating a subject of the present invention withan immunosuppressive regimen prior to, concomitantly with, or followingtransplantation of the graft. In general it will be appreciated thatengraftment of later stage grafts will require greater immunosuppressionof a graft recipients than for earlier stage grafts. The disadvantagesof immunosuppressive therapy may be clearly outweighed by the benefitsof a fully functioning organ/tissue, as in the case of a life-savingtransplantation.

Preferably, in order to facilitate engraftment of a non-syngeneic graft,the immunosuppressive regimen may advantageously comprise transientlyadministering to the subject at least one T-cell costimulation inhibitorand at least one CD40 ligand inhibitor, and more preferably may furthercomprise administering to the subject an inhibitor of T-cellproliferation.

Preferably, the T-cell costimulation inhibitor is CTLA4-Ig, the CD40ligand inhibitor is anti-CD40 ligand antibody, and the inhibitor ofT-cell proliferation is rapamycin. Alternately, the T-cell costimulationinhibitor may be an anti-CD40 antibody. Alternately, the T-cellcostimulation inhibitor may be an antibody specific for B7-1, B7-2 orCD28. Such polypeptide drugs are particularly advantageous since theseare, unlike commonly used immunosuppressant drugs like cyclosporin A,essentially non-toxic and/or non-carcinogenic, and by virtue ofpassively blocking cell surface receptor interactions, afford reversibleand temporary immunosuppression of the subject.

A suitable immunosuppressive regimen for overcoming rejection of porcinexenografts, as described in Example 6 (FIG. 8 c), is as follows:rapamycin administered subcutaneously at 1.5 milligrams per kilogram ona daily basis from day 0+8 milligrams per kilogram CTLA4-Ig, and 10milligrams anti-CD40 ligand antibody per kilogram administeredintraperitoneally on days 0, 2, 4, 6 after transplantation.

Examples of suitable types of immunosuppressive regimens includeadministration of immunosuppressive drugs, tolerance inducing cellpopulations, and/or immunosuppressive irradiation.

Ample guidance for selecting and administering suitableimmunosuppressive regimens for transplantation is provided in theliterature of the art (for example, refer to: Kirkpatrick C H. andRowlands D T Jr., 1992. JAMA. 268, 2952; Higgins R M. et al., 1996.Lancet 348, 1208; Suthanthiran M. and Strom T B., 1996. New Engl. J.Med. 331, 365; Midthun D E. et al., 1997. Mayo Clin Proc. 72, 175;Morrison V A. et al., 1994. Am J Med. 97, 14; Hanto D W., 1995. Annu RevMed. 46, 381; Senderowicz A M. et al., 1997. Ann Intern Med. 126, 882;Vincenti F. et al., 1998. New Engl. J. Med. 338, 161; Dantal J. et al.1998. Lancet 351, 623).

Examples of suitable immunosuppressive drugs include, but are notlimited to, CTLA4-Ig, anti CD40 antibodies, anti CD40 ligand antibodies,anti B7 antibodies, anti CD3 antibodies (for example, anti human CD3antibody OKT3), methotrexate (MTX), Copaxone, rapamycin, prednisone,methyl prednisolone, azathioprene, cyclosporin A (CsA), tacrolimus,cyclophosphamide and fludarabin, mycophenolate mofetil, daclizumab [ahumanized (IgG1 Fc) anti-IL2R alpha chain (CD25) antibody], and anti Tcell antibodies conjugated to toxins (for example, cholera A chain, orPseudomonas toxin).

A graft according to the present invention can be transplanted into thesubject in any of various ways, depending on the application andpurpose, so as to provide an organ/tissue-specific function to thesubject according to the teachings of the present invention. One ofordinary skill in the art, such as a transplant surgeon specialized inthe disease to be treated, will possess the necessary expertise so as toapply the teachings of the present invention for transplanting atherapeutically effective graft of the present invention to a subject ofthe present invention. It will be appreciated that that in order totreat the disease, transplanting the graft should be effected in such away as to therapeutically replace or repair the organ or tissuedisplaying pathological physiology or morphology associated with thedisease.

As used herein, the term “therapeutically effective graft” refers to agraft having structural and/or functional characteristics such thattransplantation thereof into the subject serves to treat the disease.

Transplanting a graft of the present invention may be effected innumerous ways, depending on various parameters, such as, for example,the type, stage or severity of the disease to be treated, the physicalor physiological parameters specific to the individual subject, and/orthe desired therapeutic outcome. For example, depending on theapplication and purpose, transplanting the graft may be effected byimplanting the graft into any one of various suitable anatomicallocations of the subject, using a graft consisting of a whole or partialorgan or tissue, and/or by using a graft consisting of various numbersof discrete organs, tissues, and/or portions thereof.

A graft of the present invention may be derived from a donor which is ofany one of various species. Suitable species origins for the graftcomprise the major domesticated or livestock animals, and primates,which have been extensively characterized with respect to correlation ofstage of differentiation with gestational stage may be suitable forpracticing the method. Such animals include bovines (e.g., cow), equines(e.g., horse), ovines (e.g., goat, sheep), felines (e.g., Felisdomestica), canines (e.g., Canis domestica), rodents (e.g., mouse, rat,rabbit, guinea pig, gerbil, hamster), and primates (e.g., chimpanzee,rhesus monkey, macaque monkey, marmoset).

Various methods may be employed to obtain a graft at a developmentalstage essentially corresponding to that of a porcine or human derivedgraft, as presently taught. Obtaining such a graft is optimally effectedby harvesting the graft from a developing graft donor embryo or fetus atsuch a stage of gestation. It will be understood by those of skill inthe art that the gestational stage of an organism is the time periodelapsed following fertilization of the oocyte generating the organism.

A graft at a desired developmental stage may be obtained by in-vitroculture of cells, organs/tissues. Such controlled in-vitrodifferentiation of cells, tissues or organs is routinely performed, forexample, using culturing of embryonic stem cell lines to generatecultures containing cells/tissues/organs of desired lineages. Forexample, for generation of various lineages, including endodermallineages such as liver; ectodermal lineages such as brain, skin andadrenal; and mesodermal lineages such as muscle, cartilage, mullerianduct, and heart, refer, for example, to: Schuldiner M. et al., 2000.Proc Natl Acad Sci USA. 97:11307-11312 and Itskovitz-Eldor J. et al.,2000. Mol Med 6:88; for pancreatic differentiation of embryonic stemcells, refer, for example, to: Lee S. H., et al., 2000. NatureBiotechnol. 18:675; Lumelsky et al., 2001. Science 292:1389-1394; Soriaet al., 2000. Diabetes 49:1-6; Schuldiner M. et al., 2000. Proc NatlAcad Sci USA. 97:11307-11312). For differentiation of pulmonarylineages, refer for example, to Otto W R., 1997. Int J Exp Pathol.78:291-310.

The following table provides examples of the gestational stages of humanand porcine grafts at which these can provide grafts which areessentially at corresponding developmental stages:

Corresponding gestational stages of pigs and humans. Gestational stageof Gestational stage of porcine graft (days) human graft (days) 18  4420  49 22  54 23 56-57 25 61-62 26  63 28 68-69 31  75 38  92 42 102 46112 49 119 56 136 62 151 72 175 80 195 88 214 The gestational stage (indays) of a graft belonging to a given species which is at adevelopmental stage essentially corresponding to that of a porcine graftcan be calculated according to the following formula: [gestational stageof porcine graft in days]/[gestational period of pig in days] ×[gestational stage of graft of given species in days]. Similarly, thegestational stage (in days) of a graft belonging to a given specieswhich is at a developmental stage essentially corresponding to that of ahuman graft can be calculated according to the following formula:[gestational stage of human graft in days]/[gestational period of humansin days] × [gestational stage of graft of given species in days]. Thegestational stage of pigs is about 115 days and that of humans is about280 days.

As described hereinabove, transplanting the graft may be effected bytransplantation thereof into various suitable anatomical location so asto be of therapeutic effect.

Depending on the application and purpose, the graft may be transplantedinto a homotopic anatomical location (a normal anatomical location forthe organ or tissue type of the graft), or into an ectopic anatomicallocation (an abnormal anatomical location for the organ or tissue typeof the graft). Optionally, when transplanting the graft to repair orreplace a damaged organ/tissue, the latter may be removed, for example,so as to enable growth and engraftment of the graft, for example in thecontext of organ replacement by transplantation of the graft into ahomotopic anatomical location.

Depending on the application and purpose, the graft may beadvantageously implanted under the renal capsule, or into the kidney,the testicular fat, the sub cutis, the omentum, the portal vein, theliver, the spleen, the heart cavity, the heart, the chest cavity, thelung, the pancreas and/or the intra abdominal space.

Transplanting a pancreatic organ/tissue graft of the present inventionmay be advantageously effected by transplanting the graft into theportal vein, the liver, the pancreas, the testicular fat, the sub-cutis,the omentum, an intestinal loop (the subserosa of a U loop of the smallintestine) and/or the intra-abdominal space. Preferably, transplanting apancreatic organ/tissue graft of the present invention is effected bytransplanting the graft under at least one renal capsule of the subject.Preferably, for transplanting a pancreatic organ/tissue graft into theportal vein, the pancreatic organ/tissue graft is a pancreatic isletgraft. For the omentum site, omentum will be recognized and omentalpocket will be created by circular suture legation followed by embryonictissue implantation into the pocket. Guidance for practicing therapeutictransplantation of pancreatic organ/tissue grafts according to theteachings of the present invention is provided in the Examples sectionbelow.

As is described and illustrated in the Examples section below, apancreatic or lymphoid/hematopietic organ/tissue graft can betransplanted into under a renal capsule of a mammal so as to producesignificant levels of insulin or of a hematological factor such asfactor VIII, respectively, in the serum of the subject.

As is further described and illustrated in the Examples section below, apulmonary organ/tissue graft can be transplanted into under a renalcapsule of a mammal so as to generate well developed pulmonaryorgans/tissues which comprise alveolar structures in the subject. Suchpulmonary organs/tissues can be suitably re-implanted in the thorax ofthe subject after such development in such a way as to provide pulmonaryfunction to the subject.

Depending on the application and purpose, transplanting the graft may beeffected by transplanting a graft consisting of a whole or partialorgan, and/or may be effected by transplanting a graft consisting ofvarious numbers of discrete organs, tissues, and/or portions thereof.

For example, transplanting increasing numbers of discrete organ ortissue grafts may be advantageously employed to increase thephysiological or physical therapeutic effect of the graft to desiredlevels. For example, where the graft is a graft of pancreatic islets,increasing the number of grafts can be used to generate sufficientlyhigh serum levels of a pancreatic hormone, such as insulin, so as totreat a pancreatic hormone deficiency such as type 1 diabetes.Similarly, increasing the number and/or the mass oflymphoid/hematopietic organ/tissue grafts can be used to generatesufficiently high levels of a hematopoietic factor, such as factor VIIIor glucocerebrosidase, so as to enable treatment of hemophilia A orGaucher disease, respectively.

Following transplantation, the immunological tolerance of the subject,in the case of a non-syngeneic graft, and the functional and structuralgrowth and differentiation of the graft may be advantageously monitored.

Evaluation of serum levels in the subject of essentially any biomoleculeproduced by a pancreatic or lymphoid/hematopietic organ/tissue graft,such as insulin, factor VIII, glucocerebrosidase and the like, whosedeficiency is known to be associated with a disease, can easily bemonitored according to standard medical diagnostic methods, including asdescribed in the Examples section which follows. Normalization of serumglucose levels in the serum of a diabetic subject followingtransplantation of a pancreatic islet graft is indicative of graftfunctionality (i.e., physiologically regulated insulin secretion by thegraft). In general histological graft development can be monitored viabiopsy, and gross morphological/structural graft development can bemonitored via any of various standard medical imaging and diagnosticmethods.

Various methods may be employed to assess the subject's immunologicaltolerance to the graft. For example the tolerance may be assessed bymonitoring subject-specific leukocyte or T cell specific infiltration ofthe graft, by monitoring the origin of the graft vasculature, and/or bymonitoring the histological appearance of organ or tissue specificstructures. Such monitoring may be advantageously effected usingmethods, such as via sample biopsy, known to those with skill in theart. Infiltration of subject leukocytes, neutrophils, natural killercells, or T cells into the graft, or lack thereof, are typicallyindicative of suboptimal or optimal engraftment of a non-syngeneic graftin the subject, respectively. In cases where subject tolerance of thegraft requires improvement, therapeutic adjunct immunosuppressivetreatment of the subject may be advantageously performed or adjusted, asdescribed hereinabove. It will be appreciated by the artisan that anoptimally tolerated graft is a graft not rejected or not substantiallyinfiltrated in the subject by T lymphocytes non-syngeneic with thegraft. A graft may be rejected via hyperacute rejection, acuterejection, or chronic rejection. Ample guidance for ascertaining graftrejection is provided in the literature of the art (for example, referto: Kirkpatrick C H. and Rowlands D T Jr., 1992. JAMA. 268, 2952;Higgins R M. et al., 1996. Lancet 348, 1208; Suthanthiran M. and Strom TB., 1996. New Engl. J. Med. 331, 365; Midthun D E. et al., 1997. MayoClin Proc. 72, 175; Morrison V A. et al., 1994. Am J Med. 97, 14; HantoD W., 1995. Annu Rev Med. 46, 381; Senderowicz A M. et al., 1997. AnnIntern Med. 126, 882; Vincenti F. et al., 1998. New Engl. J. Med. 338,161; Dantal J. et al. 1998. Lancet 351, 623). Graft-derivedvascularization will generally correlate with poor engraftment, and willtend to increase with the gestational stage of the graft at time ofimplantation.

It will be appreciated that the present invention enables identificationof appropriate developmental stages of organ/tissue grafts of any ofvarious lineages which can be used for treatment of essentially anydisease associated with pathological organ or tissue physiology ormorphology which is amenable to treatment via transplantation. Suchdiseases include renal, splenic, pancreatic, cardiac, hepatic,hematological, genetic, pulmonary, brain, gastrointestinal, muscular,endocrine, osseous, neural, hematological/metabolic, dermal, cosmetic,ophthalmological, and vascular diseases.

Thus, the present invention identifies developmental stages ofpancreatic, pulmonary and lymphoid/hematopietic organ/tissue grafts,such as porcine grafts which can be obtained in essentially unlimitedquantities, at which such grafts can be used to optimally treat diseasesin humans, such as type 1 diabetes and hemophilia A, which are amenableto treatment via transplantation, respectively, of pancreatic, pulmonaryor lymphoid/hematopietic organs/tissues.

It is expected that during the life of this patent many relevant medicaldiagnostic techniques will be developed and the scope of the phrase“method of evaluating the stage of differentiation of a mammalian organmost suitable for transplantation thereof into a mammalian subject” isintended to include all such new technologies a priori.

Additional objects, advantages, and novel features of the presentinvention will become apparent to one ordinarily skilled in the art uponexamination of the following examples, which are not intended to belimiting. Additionally, each of the various embodiments and aspects ofthe present invention as delineated hereinabove and as claimed in theclaims section below finds experimental support in the followingexamples.

EXAMPLES

Reference is now made to the following examples, which together with theabove descriptions, illustrate the invention in a non-limiting fashion.

Generally, the nomenclature used herein and the laboratory proceduresutilized in the present invention include molecular, biochemical,microbiological and recombinant DNA techniques. Such techniques arethoroughly explained in the literature. See, for example, “MolecularCloning: A laboratory Manual” Sambrook et al., (1989); “CurrentProtocols in Molecular Biology” Volumes I-III Ausubel, R. M., ed.(1994); Ausubel et al., “Current Protocols in Molecular Biology”, JohnWiley and Sons, Baltimore, Md. (1989); Perbal, “A Practical Guide toMolecular Cloning”, John Wiley & Sons, New York (1988); Watson et al.,“Recombinant DNA”, Scientific American Books, New York; Birren et al.(eds) “Genome Analysis: A Laboratory Manual Series”, Vols. 1-4, ColdSpring Harbor Laboratory Press, New York (1998); methodologies as setforth in U.S. Pat. Nos. 4,666,828; 4,683,202; 4,801,531; 5,192,659 and5,272,057; “Cell Biology: A Laboratory Handbook”, Volumes I-III Cellis,J. E., ed. (1994); “Current Protocols in Immunology” Volumes I-IIIColigan J. E., ed. (1994); Stites et al. (eds), “Basic and ClinicalImmunology” (8th Edition), Appleton & Lange, Norwalk, Conn. (1994);Mishell and Shiigi (eds), “Selected Methods in Cellular Immunology”, W.H. Freeman and Co., New York (1980); available immunoassays areextensively described in the patent and scientific literature, see, forexample, U.S. Pat. Nos. 3,791,932; 3,839,153; 3,850,752; 3,850,578;3,853,987; 3,867,517; 3,879,262; 3,901,654; 3,935,074; 3,984,533;3,996,345; 4,034,074; 4,098,876; 4,879,219; 5,011,771 and 5,281,521;“Oligonucleotide Synthesis” Gait, M. J., ed. (1984); “Nucleic AcidHybridization” Hames, B. D., and Higgins S. J., eds. (1985);“Transcription and Translation” Hames, B. D., and Higgins S. J., eds.(1984); “Animal Cell Culture” Freshney, R. I., ed. (1986); “ImmobilizedCells and Enzymes” IRL Press, (1986); “A Practical Guide to MolecularCloning” Perbal, B., (1984) and “Methods in Enzymology” Vol. 1-317,Academic Press; “PCR Protocols: A Guide To Methods And Applications”,Academic Press, San Diego, Calif. (1990); Marshak et al., “Strategiesfor Protein Purification and Characterization—A Laboratory CourseManual” CSHL Press (1996); all of which are incorporated by reference asif fully set forth herein. Other general references are providedthroughout this document. The procedures therein are believed to be wellknown in the art and are provided for the convenience of the reader.

Unless otherwise defined, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although methods and materialssimilar or equivalent to those described herein can be used in thepractice or testing of the present invention, suitable methods andmaterials are described below.

Example 1 Miscellaneous Materials and Methods

Transplantation of Fetal Tissue Under the Renal Capsule:

Transplantation of a graft under the renal capsule may be desired forgrafts other than renal grafts. Transplantation of fetal tissue underthe renal capsule of recipient mice was performed as previouslydescribed (Dekel, B. et al., 1997. Transplantation 64, 1541-1550). Wholefetal human or porcine organs or whole or 1-2 millimeter-diameterfragments of tissues at later stages of gestation were used intransplantations. For growth assays, transplantation was performed 7-10days following reconstitution of irradiated hosts with NOD/SCID bonemarrow. Alternatively, fetal tissues were transplanted into SCIDrecipient mice. For transplantation, fetal tissues were maintained insterile conditions at 4 degrees centigrade for approximately two hoursin either RPMI 1640 or Dulbecco's modified Eagle's medium supplementedwith 10 percent fetal calf serum (FCS; Biological Industries, BeitHaemek, Israel). Transplantation of tissues was performed under generalanesthesia induced by intraperitoneal injection of 2.5 percent Avertinin phosphate buffer saline solution (10 milliliters per kilogram bodyweight). Both host kidneys were exposed via a bilateral incision, a 1.5millimeter incision was made at the caudal end of the renal capsule, andan approximately one cubic millimeter fragment of renal tissue wasimplanted under each renal capsule. Tissues were also transplantedintra-abdominally to control for renal sub-capsular space specificimmune privilege. Transplanted mice were treated post-operatively withciprofloxacin in their drinking water for 7 days.

Analysis of Graft Vascularization:

Five micrometer thick paraffin sections were immunostained withantibodies specific for blood vessels, including PECAM-1 and CD-31,according to the manufacturer's instructions. Blood vessel counts wereperformed in similar regions within the grafts per high-power field (5consecutive fields per transplant in 5 transplants per group).

Example 2 Transplantation of 12-16 Week Fetal Human and AnimalPancreatic Organ/Tissue Grafts into a Host

Fetal human or porcine organs/tissues transplanted into a host arecapable of generating structurally and functionally differentiated,host-integrated organs/tissues optimally tolerated byalloreactive/xenoreactive human lymphocytes. Thus, while conceiving thepresent invention, it was hypothesized that transplanting fetal human oranimal pancreatic organs/tissues harvested at a defined time window intoa host will generate pancreatic organs/tissues displaying significantdevelopment, as follows.

Materials and Methods:

Donor Pancreatic Tissues:

Human 12- to 16-week gestational stage pancreatic tissues were obtainedfollowing curettage, with warm ischemia time of less than 30 minutes.Following dissection, the pancreatic tissues were kept at 4 degreescentigrade in UW solution for less than 45 minutes in sterileconditions. The study protocol was approved by the hospital (KaplanMedical Center, Rehovot, Israel) Helsinki committee.

Animal pancreatic tissues at 12- to 14-day gestational stage weremicrodissected from mouse embryos under the light microscope. Tissueswere kept at 4 degrees centigrade in RPMI 1640 medium solution prior totransplantation.

Transplantation Procedure:

Transplantation of human and animal pancreatic organs/tissues at earlystages of gestational development was performed as described in Example1 of the Examples section above with modifications. For transplantationunder the renal capsule, host kidney is exposed through a left lateralincision, a 1.5 millimeter incision is made at the caudal end of therenal capsule, and donor pancreatic tissues are grafted under the renalcapsule in [1-2]×[1-2] millimeter fragments.

Experimental Results:

Four 12- to 16-week gestational stage human pancreaticorgan/tissue-derived grafts were transplanted under the renal capsule in4 SCID and 4 normal mice. Each fragment size at transplantation was 1-2millimeters in diameter. In all immunocompetent mice rejection wasdetected beginning at 5 days posttransplantation as determined viahistological analysis indicating graft necrosis and tissue destruction.In all immunodeficient mice, graft acceptance was observed, asdetermined by growth of the graft and the absence of signs of rejectionupon histological and macroscopic examination. In a 12-week gestationalstage human pancreatic tissue-derived graft harvested at 8 weeksposttransplantation, graft size had increased 10-fold (2×2 millimeterspre-transplantation to 8×5 millimeters at harvesting).

Mouse 14-, 13-, and 12-day gestational stage pancreatic organs/tissueswere transplanted under the renal capsule in immunodeficient syngeneic(Balb/c) mice. In a 12-day gestational stage tissue-derived graftharvested 2 weeks posttransplantation, graft size had increased 10 fold(1×1 millimeter pretransplantation to 5×3 millimetersposttransplantation).

Conclusion:

Later gestational stage human or animal pancreatic organs/tissuestransplanted into hosts generate pancreatic organs/tissues displayingsignificant development. These results thus anticipate the use of 14-20week gestational stage human pancreatic grafts for treating diseaseswhich may benefit from transplantation of such (e.g., diabetes).

Example 3 Generation of Diabetic Mice

Materials and Methods:

Diabetes is induced in mouse hosts by streptozotocin treatment, aspreviously described (Soria et al., 2000. Diabetes 49, 1-6) or byalloxan (reviewed in T. Szkudelski, 2001, Physiol. Res. 50: 536-546).

Briefly, diabetes is induced in mouse hosts via a single intraperitonealinjection of 200 milligram streptozotocin (Sigma) freshly dissolved incitrate buffer (pH 4.5) per kilogram body weight. Onset of diabetes isthen confirmed and monitored by the presence of weight loss, polyuria,and blood glucose levels of less than 500 milligrams/dl. Blood forglucose tests is obtained by tail snipping and measured between 9 and 11A.M. under non-fasting conditions and analyzed with a portable glucosemeter. Two weeks following injection of streptozotocin, diabeticrecipients are engrafted with donor pancreatic tissues, and glucoselevels are monitored as described above in order to ascertainrestoration of glycemic control.

Alloxan Protocol:

To determine the capacity of the graft to regulate hyperglycemia of themouse, grafted and non-grafted (E42 embryonic pancreas 4 months aftertransplant) NOD-SCID mice were injected intravenously with Alloxan(Sigma-Aldrich 90 milligrams per kilogram), which is known to destroyrodent, but not human or porcine beta cells (Eizirik D, et al. 1994,Proc Natl Acad Sci USA 91: 9253). Alloxan was prepared by dissolving 30milligrams alloxan-monohydrate 90 percent in 1 milliliter of 1millimolar HCL solution of NaCl 0.9 percent. The dose for IV injectionis 90 milligrams per kilogram. Glucose concentrations were measured bytail tipping before alloxan treatment, 4 days and 10 days after alloxanadministration and then once weekly.

Example 4 Treatment of Diabetes by Transplantation of Early GestationalStage Human or Porcine Pancreatic Tissue into Diabetic Human Recipientswithout or with Minimal Immunosuppression of Recipients

Diabetes is a disease of tremendous medical and economic impact, howevertreatment of this disease by daily injection of insulin, the standardtherapy, does not satisfactorily prevent or alleviate its debilitatingor lethal consequences. An attempt to overcome this limitation has beentreatment of diabetes by transplantation of adult cadaveric donorpancreatic islets. However, this strategy cannot be routinely practiceddue to the insufficient numbers of immunologically matching allogeneicdonor pancreases from which to isolate the sufficient numbers of isletsrequired.

As taught in U.S. 20030096016, 7- to 8-week gestational stage humanrenal organ/tissue-derived grafts, or 20- to 28-day gestational stageporcine organ/tissue-derived grafts transplanted into hosts generatestructurally and functionally differentiated, renal organs/tissues ofgraft type optimally tolerated by alloreactive/xenoreactive humanlymphocytes.

Examples 5 and 6 herein are incorporated as comparative examples. Thesuccess of those studies was judged on the basis of morphological,histological and immunochemical data. The present invention now showsfor the first time functional data that supports transplantation offetal pancreatic, splenic and pulmonary tissue at a later gestationalstage than that previously described.

Example 5 Transplantation of 8 Week Human Pancreatic Organ/Tissue Grafts

Transplantation of 8-week gestational stage human, or 27- to 28-daygestational stage porcine, pancreatic organ/tissue grafts generates, inthe absence of graft-derived teratomas, insulin-producing pancreaticorgans/tissues which will be optimally tolerated byalloreactive/xenoreactive human lymphocytes. This example is provided asa comparative example.

Allogeneic donor pancreatic organ/tissue transplantation remains theoptimal therapeutic option in case of pancreatic failure. However,therapeutic transplantation of pancreatic organ/tissue grafts derivedfrom an allogeneic donor is often impossible to implement due tohaplotype-matching barriers. Moreover, even when a matched donor isfound, in order to prevent graft rejection such transplantation requirespermanent graft recipient immunosuppression, usually via administrationof toxic immunosuppressant drugs such as cyclosporin A. Suchimmunosuppressive treatments contribute to the drawbacks of allogeneictransplantation, since these are often unsuccessful at preventing graftrejection in the short term, and are usually incapable of indefinitelypreventing graft rejection. An alternative to allograft transplantationinvolves transplantation of xenografts, in particular porcine grafts,which are considered the optimal animal alternative to human grafts.However, xenografts generally cannot be used for transplantation due tohighly suboptimal tolerance of such grafts by human lymphocytes. Thus,pancreatic organs/tissues suitable for therapeutic transplantation inhumans and tolerated by non-syngeneic human lymphocytes, and adequatesources of such organs/tissues, are highly desired.

One potent strategy for providing pancreatic organs/tissues fortransplantation involves using fetal grafts of such organs/tissues,since it has been demonstrated that the earlier the developmental stageof an organ/tissue, the better it is tolerated when transplanted into anon-syngeneic host. However, to date, generation of pancreaticorgan/tissue graft-derived tissues/organs displaying satisfactory growthand differentiation in the absence of graft-derived teratomas, andsatisfactory immunological tolerance by alloreactive/xenoreactive humanlymphocytes, without or with minimal immunosuppression, has not beenachieved.

It was hypothesized that there exists a fetal developmental stage duringwhich pancreatic organs/tissues are sufficiently differentiated to becommitted to pancreas specific development in the absence ofgraft-derived teratomas while being sufficiently undifferentiated so asto be optimally tolerated when transplanted into a non-syngeneic host.While reducing the present invention to practice, the existence ofspecific gestational stages during which human or porcine pancreaticorgans/tissues can be transplanted into a host so as to generate, in theabsence of graft-derived teratomas, structurally and functionallydifferentiated insulin-producing organs/tissues which will be optimallytolerated by alloreactive/xenoreactive human lymphocytes wereunexpectedly uncovered, as described below.

Materials and Methods:

Harvesting of Human Gestational Stage Pancreatic Organs/Tissues:

Human gestational stage pancreatic organs/tissues for transplantationwere obtained by extraction of organ/tissue fragments followingvoluntary abortions performed mechanically by aspiration at agestational stage of 8 weeks, after obtaining informed consent. The warmischemia time of the harvested samples was kept at less than 30 minutes,and following dissection, the organ precursors were kept at 40 degreescentigrade in UW solution or PBS for less than 45 minutes under sterileconditions. The study protocol was approved by the hospital (KaplanMedical Center, Rehovot, Israel) Helsinki committee.

Harvesting of Porcine Gestational Stage Pancreatic Organs/Tissues:

Porcine gestational stage pancreatic organs/tissues for transplantationwere obtained with the assistance of the Lahav Institute for animalresearch, Kibbutz Lahay. Developing tissues were harvested at agestational stage of 27-28 days from pregnant sows operated on undergeneral anesthesia. The study protocol was approved by the localinstitute's Ethics Committee. Tissues for transplantation were extractedunder a light microscope and were kept in sterile conditions at 40degrees centigrade for about two hours in RPMI 1640 (BiologicalIndustries, Bet HaEmek, Israel) prior to transplantation.

Transplantation Procedure:

Transplantations were performed in Balb/c×NOD/SCID chimeras or NOD/SCIDmice under general anesthesia induced by intraperitoneal injection of2.5 percent Avertin in PBS (10 milliliters per kilogram). Fortransplantation under the renal capsule, the host kidney was exposedthrough a left lateral incision. A 1.5-mm incision was made at thecaudal end of the renal capsule, and 1-2 millimeter-diameter fragmentsof gestational stage pancreatic tissue were implanted under the renalcapsule.

Histological Analysis:

Anti cytokeratin antibody clone MNF 116 (non-cross-reactive with mousetissues) was used for immunostaining porcine epithelium; and antiinsulin antibody and anti human vimentin antibody clone V9(non-cross-reactive with mouse tissues; used for staining humanmesenchymal cells) were obtained from DAKO. Tissues were fixed byovernight incubation in 4 percent paraformaldehyde in PBS, the fixedtissues were processed through graded alcohols, through xylenes, andparaffin-embedded. Four micron-thick sections of embedded tissues werecut and mounted on positively charged glass slides. The slide-mountedtissue sections were deparaffinized in xylenes following rehydration ingraded alcohols. Endogenous peroxidase was quenched in 0.6 percenthydrogen peroxide in 70 percent methanol for 20 minutes. Antigenretrieval by microwave boiling or protease pretreatment was applied whenneeded. For immunostaining, slides were incubated in a humidifiedchamber for 60 minutes with primary antibody, following application ofDAKO Envision TM+ system, horseradish peroxidase (HRP). Diaminobenzidine(DAB) or aminoethylcarbasole (AEC) reagents were used as chromogens. Theslides were hematoxylin counterstained and mounted.

Experimental Results:

Transplantation of Porcine 27- to 28-Day Gestational Stage PancreaticXenografts Engraft and Display Functional and Structural PancreaticDifferentiation:

Grafts derived from 27- to 28-day gestational stage porcine pancreastransplanted under the renal capsule of NOD/SCID mice clearly displayedpancreas specific structural and functional differentiation, 6 weeksposttransplantation. Grafts derived from 28-day gestational stageporcine liver transplanted into spleens of such mice which were examined5 weeks posttransplantation displayed significant pancreatic growth.Pancreatic structural differentiation was clearly evident 6 weeksposttransplantation by a graft derived from 27-day gestational stageporcine pancreatic tissue as determined via H&E-stained graft tissuesections which showed differentiation of pancreatic lobular structureswith ductal and acinar pancreatic structures. Pancreatic functionaldifferentiation was also evident at 6 weeks posttransplantation intissue sections of a graft derived from 27-day gestational stage tissuein the form of insulin and pancreatic peptide synthesis Immunostainingof a graft derived from 28-day gestational stage porcine pancreatictissue with anti cytokeratin antibody clearly showed differentiation ofgraft derived pancreatic ductal epithelia.

Human 8-Week Gestational Stage Pancreatic Allografts Engraft and DisplayFunctional and Structural Pancreatic Differentiation:

Grafts derived from 8-week gestational stage human pancreatic tissuetransplanted under the renal capsule of NOD/SCID mice bearingalloreactive human lymphocytes clearly displayed pancreas specificstructural and functional differentiation, 6 weeks posttransplantation.Pancreatic functionality of the graft was convincingly demonstrated bydifferentiation of insulin-positive beta-cells within pancreatic islets.Furthermore, grafts derived from 8-week gestational stage humanpancreatic tissue transplanted under the renal capsule ofBalb/c×NOD/SCID chimeras bearing alloreactive human PBMCs also clearlydisplayed pancreas specific structural and functional differentiation,as shown via differentiation of vimentin positive human mesenchymalcells.

Conclusion:

The above-described results demonstrate that 8-week gestational stagehuman, or 27- to 28-day gestational stage porcine, pancreatictissue-derived grafts are capable of generating, in the absence ofgraft-derived teratomas, structurally and functionally differentiatedinsulin-producing pancreatic organs/tissues which will be optimallytolerated by alloreactive/xenoreactive human lymphocytes. However, as isevident from the above-results, fetal pancreatic organ/tissue graftharvested from a porcine donor at a later stage, i.e. over E35, andpreferably about E42 to about E56, provide superior grafts which arefeatures by functional and enduring characteristics as compared tografts harvested at E28.

Example 6 Identification of Gestational Stages of Functional PorcinePancreatic Organ/Tissue Grafts Capable of Significant Organ-SpecificDevelopment with No/Minimal Risk of Teratoma Formation

There is an urgent need for sources of grafts suitable for therapeutictransplantation for treatment of diseases involving failure oforgans/tissues such as liver, heart, pancreas or lung. Optimally, suchgrafts should have the capacity to display adequate development intosuch organ/tissue types while having minimal potential forimmunogenicity resulting in graft rejection following transplantationinto a host. Furthermore, the grafted tissue should perform thefunctions necessary for the particular tissue. One approach which hasbeen advocated for more than two decades involves the use of porcinefetal grafts at gestational stages sufficiently advanced so as to enablesuitable/optimal organ-specific development, and sufficiently early soas to avoid/minimize risk of teratoma formation, such as described aboveand in the literature (Dekel B. et al., 2003. Nat Med 9:53-60) withrespect to porcine gestational stage renal grafts. It will beappreciated, however, that different organ/tissue types differentiateoverall at different gestational stages, that organs/tissues atincreasing gestational stages will generally have decreasing capacity toinduce teratoma formation by virtue of generally comprising decreasingnumbers of pluripotential cells. It will be further appreciated thatspecific organ/tissue types may be composed of distinct combinations oftissue sub-types, for example including stromal tissues, which may be atdifferent stages of differentiation with respect to each other withinthe same organ/tissue type. Therefore, it will be appreciated thatgestational stages during which different organ/tissue types aresufficiently advanced so as to have the capacity to displaysuitable/optimal organ-specific development, and gestational stagesduring which such organ/tissue types are sufficiently differentiated soas to avoid/minimize risk of teratoma formation and exhibit reducedimmunoreactivity will independently and unpredictably vary betweendifferent organ/tissue types. Thus, a primary and major drawback toprior art approaches is that these cannot predict whether there evenexists, for fetal organs/tissues gestational stages which aresufficiently advanced for grafts thereof to have the capacity to displayadequate/optimal organ-specific development with no or minimal risk ofteratoma formation following transplantation thereof into a host.Moreover, even if such gestational stages of such organs/tissues do infact exist, a further drawback of the prior art is that it is unknownwhat the timing of such gestational stages might be.

While reducing the present invention to practice, as described below,the present inventors have performed trial and error experiments whichfor the first time unexpectedly prove that there indeed exist, and forthe first time provide data serving to define, the timing of gestationalstages during which pancreatic, splenic and pulmonary organ/tissuegrafts specifically have the capacity to differentiate intoadequately/optimally developed organs/tissues of such types withno/minimal risk of teratoma formation following transplantation, whileeliciting minimal host immune response. As such, the experimental dataprovided below enables therapeutic transplantation methods, whichoverwhelmingly overcome the critical limitations of the art.

Materials and Methods:

Animals:

Animals were maintained under conditions approved by the InstitutionalAnimal Care and Use Committee at the Weizmann Institute Immune deficientNOD/SCID mice at the age of 8-10 weeks (Weizmann Institute AnimalBreeding Center, Rehovot, Israel) were used as hosts for thetransplantation studies. All mice were kept in small cages (up to 5animals in each cage) and fed sterile food and acid water containingciprofloxacin (20 milligrams per milliliter).

Porcine Fetal Tissues:

Porcine pancreas, spleen and lung precursors, were obtained from theLahav Institute. Pregnant sows were operated at precise stages of thepregnancy (E21, E24, E28, E42, E56, E80 and E100) under generalanesthesia. The sows were fertilized by artificial insemination. Time ofgestation is defined as the time elapsed from fertilization. The day ofinsemination is designated as E0. E1 begins at the end of E0. The studyprotocol was approved by both ethic committees at Kibbutz Lahav and theWeizmann Institute. Warm ischemia time was less than 10 minutes and theembryos were transferred in cold PBS. Tissues for transplantation wereextracted under the stereoscope and were maintained under sterileconditions at 40 degrees centigrade in RPMI 1640 (Biological Industries,Beit HaEmek, Israel) prior to transplantation. Cold ischemia time priorto transplantation was approximately 2 hours.

Kidney Sub-Capsular Transplantation:

Transplantation of porcine and mouse embryonic tissue precursors wereperformed under general anaesthesia (2.5 percent Avertin in PBS, 10milligrams per kilogram intraperitoneally). Host kidney was exposedthrough a left lateral incision. A 1.5-mm incision was made at thecaudal end of the kidney capsule and donor precursors were grafted underthe kidney capsule in fragments 1-2 millimeter in diameter.

Transplant Growth Analysis:

The animals receiving implants were sacrificed at 6-8 weeks followingtransplantation. Organs bearing the transplanted grafts were thenremoved and either fixed in 10 percent paraformaldehyde or kept frozen.Fixed grafts in paraformaldehyde were dehydrated, embedded in paraffinand sequentially sectioned and mounted on slides coated withpoly-L-lysine and sections were stained by hematoxylin-eosin (H+E).

The long (L) and short (W) axes of the grafts were measured and thepost/pretransplant size ratio was calculated by multiplying L×W, bothfor the original (pretransplant) and the graft at the time of sacrifice.

Transplant Differentiation Analysis:

Immunohistochemical staining for porcine pancreatic markers includedinsulin, glucagons, pancreatic polypeptide, chromogranin, specificpancreatic cytokeratin (CK116) and vimentin (V9). Lung grafts werestained with porcine cytokeratin and vimentin. Spleen grafts werestained with porcine Factor VIII.

Functional Response Analysis:

Serial bleedings at 2, 4, 6, and 8 weeks posttransplantation wereperformed from the retro-orbital plexus. Serum was separated and keptfrozen for porcine albumin and insulin ELISAs.

Immunosuppression Protocols:

Gestation age E42 fetal porcine pancreas was transplanted into NOD-SCIDor immunocompetent C57BL/6 mice with different immunosuppressionregimens. The successful regimens were:

1. Rapamycin at 1.5 milligrams per kilogram administered subcutaneouslyon a daily basis from day 0+CTLA4-Ig 200 micrograms per mouse given IPon days 0, 2, 4, 6 after transplantation.

2. Rapamycin at 2.5 milligrams per kilogram on days 0-4 and then 1.5milligrams per kilogram on a daily basis, administeredsubcutaneously+CTLA4-Ig 200 micrograms per mouse administeredintraperitoneally on days 0, 2, 4, 6 after transplantation.

3. Rapamycin at 1.5 milligrams per kilogram administered subcutaneouslyon a daily basis from day 0+CTLA4-Ig 200 micrograms per mouse andanti-CD40 ligand 250 micrograms per mouse administered intraperitoneallyon days 0, 2, 4, 6 after transplantation.

4. Rapamycin at 1.5 milligrams per kilogram administered subcutaneouslyon a daily basis starting on day 0 for 2 weeks+CTLA4-Ig 200 microgramsper mouse and anti-CD40 ligand 250 micrograms per mouse administeredintraperitoneally on days 0, 2, 4, 6 after transplantation.

5. Rapamycin at 1.5 milligrams per kilogram administered subcutaneouslyon a daily basis from day 0+CTLA4-Ig 200 micrograms per mouseadministered intraperitoneally on days 0, 2, 4, 6 aftertransplantation+COP1 0.2 milligrams per mouse administeredsubcutaneously on a daily basis from day −7.

Experimental Results:

Identification of Gestational Stages of Porcine Pancreatic, Splenic andPulmonary Grafts Capable of Optimal Organ-Specific Differentiation:

The potential to induce teratomas, as opposed to fully committed tissuedevelopment, was defined in different tissue precursors at differenttime points of the porcine embryonic development, by implantation intoSCID mice.

Implantation of lung precursor tissue, similar to implantation of 24-daygestational stage pancreas, was not associated with teratomas. However,this outcome likely reflects entirely different causes as can be deducedfrom the growth potential of the two tissues. Whereas pancreatic tissuegrafts are associated as early as day 24 of gestation with marked growthand development in the absence of teratoma formation, implantation oflung embryonic tissue does not exhibit appreciable growth potentialprior to or at day 42 of gestation. At this relatively late gestationtime the presence of pluripotential embryonic stem cells might bediminished in most of the embryonic tissues. Surprisingly though, fullyfunctional organs were generated.

Identification of Gestational Stages of Porcine Pancreatic, Pulmonaryand Splenic Grafts Enabling Optimal Organ-Specific Development withNo/Minimal Risk of Teratoma Formation Following Transplantation:

Following the establishment of the earliest gestational time points atwhich grafts present no or minimal teratoma risk, transplantationexperiments were performed to identify gestational stages of gestationalstage porcine pancreatic, pulmonary and splenic grafts optimal fordevelopment of such organs/tissues.

Pancreatic Organ/Tissue Grafts:

Table 1 shows the development of pancreatic organ/tissue grafts, basedon histological analysis of transplanted tissue. The embryonic pancreasprecursor tissues, obtained at different gestational ages, wereimplanted under the kidney capsule. Tissue growth and development wereevaluated 6 weeks after implantation.

Gestational stages of porcine pancreatic organ/tissue grafts capable ofgenerating growing, structurally and functionally differentiated,insulin-secreting, pancreatic tissues in the absence of teratomaformation following transplantation were identified. None of theimplanted mice exhibited teratoma growth. Histological analysis ofgrowing embryonic porcine pancreatic precursor tissue revealed thatpancreas development following implantation of all stages is free ofteratoma risk and displays marked growth and development, as exemplifiedby the presence of fully developed exocrine and endocrine components ofthe pancreas. At E42 pancreatic components are positively stained tocytokeratin 20, characterizing the pancreas epithelium, and the donororigin of the pancreatic epithelium is demonstrated by selectivestaining for cytokeratin MNF116, which is not cross-reactive with mouseepithelial cells. FIGS. 1 a-f show immunohistological staining of an E42porcine pancreas graft 6 weeks after transplantation. H&E staining (FIG.1 a), cytokeratin 20 (FIG. 1 b), vimentin (v9) (FIG. 1 c), anti-mouseCD31 (FIG. 1 d), insulin (FIG. 1 e), Ki67 (FIG. 1 f).

TABLE 1 Development of teratoma versus specific organ growth followingtransplantation of fetal porcine pancreas. Porcine pancreas precursorsHistological findings gestational age Ducts and acini IsletsTeratoma-like structures E-24   6/10  4/10  0/10 E-28   7/12  6/12  0/12E-42  14/15 12/15  0/15 E-56   9/13 11/13  0/13 E-80   8/10  7/10  0/10E-100 2/7 2/7 0/7

The transplanted fetal porcine graft, harvested at about E42 to aboutE56 remains functional for extended periods of time, as seen in FIGS. 2a-e. An E56 fetal pancreatic organ/tissue graft is shown three monthsposttransplantation. The graft is vascularized (FIG. 2 a), stainspositively for H&E (FIG. 2 b) and remains positive for insulin (FIG. 2c), pancreatic polypeptide (FIG. 2 d) and Ki67 (FIG. 2 e). Functionalityof the islets is documented by positive staining for porcine insulin,glucagon and pancreatic polypeptide. Similarly to mature isletorganization, most of the cells within the grafts' islets secreteinsulin, while glucagon secretion is detected only in the islets'periphery. The neuroendocrine origin of the islet cells is supported bypositive staining for chromogranin.

Surprisingly, when functionality assays were carried out, the laterstage fetal grafts performed much better.

Table 2 shows the graft size and serum levels of porcine insulin aftertransplantation of porcine embryonic pancreas of different gestationalages, 6 weeks posttransplantation.

Analysis of pancreatic precursor tissue obtained at different gestationtime points revealed that insulin secretion is optimal upontransplantation of 28- to 56-day gestational stage pancreatic embryonicprecursors relative to tissues obtained at day 80 of gestation whichexhibited a markedly reduced ability to secrete insulin.

TABLE 2 Optimal growth and functional differentiation (insulinsecretion) of pancreatic organs derived from E28-E56 porcine pancreaticxenografts Gestational stage of grafts* E24 E28 E42 E56 E80 E100 (n = 6)(n = 7) (n = 14) (n = 14) (n = 10) (n = 5) Graft size (mm² ± SD) 11.3 ±8.6  15.7 ± 11.2 33.7 ± 15.5 29.3 ± 13.2 7.8 ± 8.8  0.2 ± 0.07 Porcineinsulin (mIU/ml ± SD)   2 ± 1.5 4.2 ± 3.3 5.1 ± 4   5.9 ± 7.1 1.2 ± 1.40.6 ± 0.7 To evaluate in-vivo the functionality of pancreaticorgan/tissue grafts, porcine insulin secretionin the serum oftransplanted mice was monitored via ELISA. Physiological levels ofporcine insulin secretion were detected following implantation ofpancreatic organ/tissue grafts implanted at different gestationalstages. *number of engraftments shown in parentheses

The ability of the grafts to secrete insulin into the serum of NOD-S CIDrecipient mice was followed by specific ELISA, in which the primaryporcine anti-insulin antibody does not cross-react with mouse insulin. Asummary of the porcine insulin levels 6 weeks after transplantationdetected in mice with porcine pancreatic organ/tissue grafts obtained atdifferent gestational ages is shown in FIG. 3. Additionally, prior toimplantation these embryonic tissue precursors were found to besubstantially vascularized as indicated by staining with anti-CD31antibody. FIGS. 4 a-d show that porcine endothelial cells (lining alongblood vessels) marked by CD-31 positive staining (dark, and arrow) aredemonstrated in embryonic pancreas of various gestational ages. FIGS. 4a-d represent gestational stages E24, E27, E35 and E42, respectively.

The above results demonstrate that a fetal porcine graft at greater thanE28 but less than E80, preferably E42 to about E56, generates afunctional, host-vascularized pancreas. Both the graft size and insulinsecretion levels are greater in the grafts from the E42-E56 embryos thanfrom the E24-E28 embryos.

Table 3 shows the results of a glucose challenge test in NOD-SCID micetransplanted with fetal pancreas tissue. T-zero (TO) refers to thetransplantation day while T30 refers to 30 days posttransplantation.Gestational age refers to the age at which the fetal porcine graft washarvested.

FIG. 5 shows the long term follow-up of porcine insulin levels detectedin the serum of NOD-SCID mice. FIGS. 5 a-d represent porcine insulinlevels secreted from pancreatic E28, E35, E42 and E56 gestational stagetissues.

FIG. 6 shows the normalization of glucose levels in NOD-SCID micetransplanted with E42 fetal porcine pancreas grafts, following alloxantreatment (see Example 3 hereinabove). Alloxan selectively kills themouse pancreas and leaves the transplanted porcine pancreas intact. Thisexperiment unequivocally shows the survival and functionality of thetransplanted pancreatic tissue.

TABLE 3 Glucose and insulin levels in mice transplanted with porcinefetal pancreas T0 T30 Glucose Insulin Glucose Insulin mg/dl mIU/ml mg/dlmIU/ml Gestational (average ± (average ± (average ± (average ± age sd)sd) sd) sd) E24  72 ± 7  0.85 ± 0.7  537 ± 47  2.1 ± 2.9 E42  61 ± 102.8 ± 2.9 429 ± 148    9 ± 5.9* E56  67 ± 25 1.7 ± 3.4 442 ± 112  12.6 ±8.7** E80  57 ± 11 0.9 ± 3.5 478 ± 75     1.9 ± 3.4*** E100 53 ± 7  0.09± 0.02 378 ± 53  0.02 ± 0.05 *p < 0.002 **p < 0.0001 ***p < 0.02

Isolation and transfer of human PBMCs. Human PBMC were generated frombuffy coats obtained from normal volunteers, layered onto Ficoll-Paquesolution and spun at 2000 rpm for 20 min. The interface layer wascollected, washed twice, counted, and resuspended to the desired cellconcentration. 80 human cells were injected intraperitoneally, 1-3 daysafter transplantation of the human or pig pancreatic precursors intoNOD-SCID mice. Control mice did not receive human PBMC.

The immunogenic response of porcine fetal grafts was determined frommice transplanted with fetal porcine pancreas grafts harvested fromdifferent gestational ages. Table 4 shows the histological results thatcharacterize the pancreas transplants following infusion of humanperipheral blood mononuclear cells (PBMCs) into the host immunodeficientSCID mice.

This semi-quantitative grade reveals increasing cellular infiltrationand fibrosis with decreasing amounts of pancreatic components as thegrafts' gestational age increases (E56 to E100), reaching statisticaldifference when comparing cellular infiltration in the E42 vs. E80 andE100 grafts (p<0.03). In addition, 6 weeks after transplantation,complete destruction and fibrosis appear in grafts obtained at E80 orE100 compared with earlier transplanted pancreatic precursors. However,in E42 and E56 grafts pancreatic tissue is still detected, despite thepresence of human-PBMCs (stained for anti-human-CD45).

TABLE 4 Histological findings characterizing pig pancreatic transplantsfollowing infusion of human PBMCs into NOD-SCID mice.* Without HumanPBMCs With Human PBMCs Gestational Ducts/ Cellular Ducts/ Cellular stageIslets acini infiltrate Fibrosis Islets acini infiltrate Fibrosis E24 0.75 ± 0.5  0.75 ± 0.5  0.5 ± 0.6 0.5 ± 0.5 0.3 ± 0.5 0.6 ± 0.6 1.3 ±0.6 1.3 ± 0.6 E28  1.6 ± 0.6 1.6 ± 0.6 0.7 ± 0.6 1 ± 1 0.3 ± 0.6 1.3 ±0.6 1.3 ± 0.6 1.7 ± 0.6 E42  2.8 ± 0.4 2.6 ± 0.5 0.8 ± 0.8 1.2 ± 0.4 1.8± 0.8 1.8 ± 0.8   2 ± 0.7 1.6 ± 0.5 E56  2.75 ± 0.5  2.75 ± 0.5  0.25 ±0.5  0.75 ± 0.5  1.4 ± 0.5 1.75 ± 0.5  2.5 ± 0.4 2.12 ± 0.2  E80  1.3 ±0.6 1.7 ± 0.6 0.7 ± 0.6 1.7 ± 0.6 0.7 ± 0.6 1.5 ± 0.5 3 ± 0 2.3 ± 0.3E100 0.8 ± 0.5 0.3 ± 0.6 0.3 ± 0.5 3 ± 0 0.3 ± 0.6 0.3 ± 0.6 3 ± 0 2.3 ±0.6 *Semi-quantitative grade to various histological components: Islets-1+, 1 islet; 2+, 2-4; 3+, >4 islets per HPF. Ducts and acini- 1+, 1-2;2+, 2-5; 3+, >5 ducts/acini per HPF. Cellular infiltration (humanCD45-positive cells)- 0-1+, sapres infiltrate; 2+, focal denseinfiltrate; 3+, diffuse dense infiltrate. Fibrosis grading: 1+, looseconnective tissue; 2+, focal distribution of dense fibrosis; 3+, densedistributed fibrosis.

FIGS. 7 a-d show the level of tissue rejection of porcine embryonicpancreatic tissues (E56 and E80) mediated by human PBMCs, 6 weeks aftertransplantation under the kidney capsule in NOD-SCID mice. FIG. 7 ashows H&E staining of E56 pig pancreatic tissue. The tissue is focallyinfiltrated by human PBMCs (arrows), while other components of thepancreas such as acini (arrowhead) or islets (asterisk) can be detected.FIG. 7 b shows focal infiltration of human PBMCs in the E56 graft asstained for anti-human CD45. FIG. 7 c shows H&E staining of an E80pancreatic organ/tissue graft. The graft undergoes tissue destruction,fibrosis, and focal hemorrhages with minimal residues of the pancreatictissue. FIG. 7 d shows human PBMCs stained with anti-human CD45 antibodyinvading the E80 pancreatic organ/tissue graft.

FIGS. 8 a-c shows the pancreatic tissue harvested from a fetal porcinedonor gestational age E42. FIG. 8 a shows the tissue in a NOD-SCIDmouse, while FIG. 8 b shows the tissue in an immunocompetent C57BL/6mouse. FIG. 8 c shows the tissue in a mouse treated with the followingimmunosuppressive regimen: rapamycin administered subcutaneously at 1.5milligrams per kilogram on a daily basis from day 0+200 microgramsCTLA4-Ig per mouse (i.e. 8 milligrams per kilogram), and 250 microgramsanti-CD40 ligand antibody per mouse (i.e. 10 milligrams per kilogram)administered intraperitoneally on days 0, 2, 4, 6 after transplantation.The immunosuppressive regimen allows survival of the porcine tissue andovercomes any problems of immune rejection. This protocol corresponds toimmunosuppression regimen number 3 described under the Materials andMethods section, above.

Example 7 Identification of Gestational Stages of Functional PorcinePulmonary Grafts Capable of Significant Organ-Specific Development withNo/Minimal Risk of Teratoma Formation

For details of Material and Methods, see Example 6, supra.Identification of gestational stages during which porcine pulmonarygrafts are capable of generating, with no/minimal risk of teratomaformation, growing, normally differentiated alveolar pulmonary tissuesfollowing transplantation into xenogeneic recipients: In contrast tokidney, liver, pancreas or heart embryonic tissue implantation,implantation of porcine lung tissue grafts at 24, 28 or even 42 days ofgestation, did not lead to significant growth. Pulmonary tissue growthand differentiation was only detected following implantation ofprecursor tissue at the relatively late gestational stage of 56 days.Following subcapsular implantation of lung tissue at a gestational stageof 24, 28 or 42 days no teratoma formation was detected and only someepithelial and fibrous cells were found 6 weeks posttransplantation.However, as can be seen in FIGS. 9 a-d, 56-day gestational stage lungprecursor grafts displayed impressive growth (FIG. 9 a), and developedinto mature lung tissue containing all respiratory system elementsincluding respiratory bronchi, bronchioles and alveoli (FIG. 9 b, arrow,asterisks, arrow heads, respectively), and cartilage (intense bluestaining by alcian-blue FIG. 9 c). Appropriate types of epithelial cellsfor lung tissue were detected lining the different lung structures.Importantly, as can be seen in FIG. 9 d, the alveoli generated from the56-day gestational stage grafts exhibited thin inter-alveolar septacomprising capillary plexuses within, supported by minimal amounts offine connective tissue, fulfilling the fine perfusion-ventilationbalance requirement for enabling extra-uterine gas exchange. Although80-day gestational stage porcine lung grafts also developed into lungtissue, the developed tissues were significantly smaller than thosederived from 56-day gestational stage grafts (p<0.001). In addition tothe suboptimal growth potential, abnormal microscopic findings includingalveolar wall thickening and epithelial dysplasia, were evident. Thedifferences in alveolar wall structure and thickness of lung tissuesgenerated by 56- and 80-day gestational stage implants can readily beseen in FIGS. 4 d-e, respectively, following H&E staining.

Discussion:

Thus, it is hard to know if engraftment failure of fetal porcine tissuesreported in large animal studies or in humans, is only mediated byrejection or could also be attributed to a choice of embryonic tissuewith weak growth potential collected at sub-optimal gestation time. Thisissue is clearly illustrated by the present data which shows that theoptimal gestational stage for pancreatic organ/tissue graft implantationis between days 28 to 56 of gestation, while the growth potential andinsulin secretion capacity is significantly reduced upon implantation oftissue obtained beyond day 80 of gestation, at which time most of thetransplants in humans were carried out (Reinholt F P. et al., 1998.Xenotransplantation 5:222-5; Groth C G. et al., 1998. TransplantationProceedings 30:3809-10).

While establishment of the upper gestational stage threshold above whichteratomas are unlikely to develop following graft transplantation wasachievable for all of the tested organ/tissue types, defining the lowergestational stage threshold below which potential growth is suboptimalrepresented a more difficult challenge for organ types, such as lung,whose functional performance cannot be established by secretion of aprotein into the blood, as is the case with pancreas or spleen.

Contrary to the gestational stage time window identified for pancreaticgrafts, early gestational stages were not favorable for development ofgestational stage pulmonary grafts. Thus, development of E28- to E42gestational stage pulmonary grafts was not observed, while rapidlygrowing and differentiated lungs containing essentially all componentsof the adult respiratory tree, including mature alveoli, were formedfollowing implantation of E56- or E80 gestational stage pulmonarygrafts. At a gestational stage of 80 days, however, gestational stagepulmonary grafts were unexpectedly found to be suboptimal since theseexhibited both decreased growth potential and suboptimal pulmonarytissue development characterized by alveolar wall thickening andepithelial dysplasia.

Conclusion:

The presently described data unexpectedly demonstrate for the first timethat there exist for each of porcine gestational stage pancreatic orpulmonary organs/tissues, gestational stages during which grafts of suchorgans/tissues have the capacity to generate, with no/minimal risk ofteratoma formation and minimal host immune response, growing,structurally and functionally differentiated organ-specific tissuesfollowing transplantation. The presently disclosed data furtherunexpectedly demonstrates for the first time that such gestational stageporcine organs/tissues each have distinct gestational stages duringwhich these have the capacity to generate, with no/minimal risk ofteratoma formation, growing, structurally and functionallydifferentiated organ-specific tissues following transplantation. Thus,the presently disclosed data unexpectedly succeeded in characterizingfor the first time, for each of such organs/tissues, the gestationalstages of grafts during which these have the capacity to generate, withno/minimal risk of teratoma formation, growing, structurally andfunctionally differentiated organ-specific tissues followingtransplantation. In particular, the presently disclosed dataunexpectedly demonstrate for the first time that porcine pancreaticorgan/tissue grafts at gestational stages ranging from about day 24 toabout day 80 have the capacity to generate, with no/minimal risk ofteratoma formation, growing, structurally and functionallydifferentiated, insulin-secreting pancreatic tissues followingtransplantation, with those at gestational stages ranging from about day28 to about day 56 having the capacity to generate optimally growing andstructurally and functionally differentiated, insulin-secretingpancreatic tissues.

Moreover, the presently disclosed data unexpectedly demonstrate for thefirst time that porcine splenic grafts at gestational stages rangingfrom about day 24 to about day 80 with those at gestational stagesranging from about day 42 to about day 56 having the capacity togenerate, with no/minimal risk of teratoma formation, optimal growing,structurally and functionally differentiated spleen tissue.

Additionally, the presently disclosed data unexpectedly demonstrate forthe first time that the optimal gestational stage for transplantation ofporcine pulmonary grafts is at about day 42 and less than about day 80of gestation, with 56-day gestational stage grafts having the capacityto generate, with no/minimal risk of teratoma formation, optimallygrowing and structurally and functionally differentiated pulmonarytissues.

As such, the presently described methods of transplanting porcinegestational stage pancreatic, and pulmonary grafts are overwhelminglysuperior to known methods, and are therefore optimal for treatingdiseases associated with failure of organs of such types.

Example 8 Identification of Gestational Stages During which MouseSplenic Grafts are Capable of Generating Growing Splenic Organs

Background:

Numerous highly debilitating/lethal diseases caused by abnormal activityor expression of a biomolecule for which there are no optimal treatmentmethods are associated with a deficiency in a substance which isproduced by hematopoietic/stromal cells which may be found inlymphoid/hematopietic organs/tissues such as spleen. Such diseasesinclude, for example, hemophilia A or Gaucher disease which arerespectively associated with factor VIII or glucocerebrosidasedeficiency.

The present invention provides a method to treat such diseasescomprising transplantation of fetal allogeneic lymphoid/hematopieticorgans/tissues which would have the great advantage of obviating therequirement for enzyme replacement therapy, the state-of-the-arttreatment method for such diseases. However, to date, it is unknownwhether and how it may be possible to optimally achieve such therapeutictransplantation in the absence of teratoma formation. While conceivingthe present invention, the present inventors hypothesized thatlymphoid/hematopietic organ/tissue grafts at the appropriate gestationalstage would have the capacity to generate growing, normallydifferentiated splenic organs with no/minimal risk of teratoma formationfollowing transplantation and minimal host immune response into asyngeneic/allogeneic host. Thus, while reducing the present invention topractice, the present inventors have successfully validated thishypothesis, as described below, thereby overcoming critical limitationsof the art.

Materials and Methods:

For details see Example 6, supra. Transplantation of gestational stagesplenic grafts into syngeneic/allogeneic mouse recipients: The earliestgestational stage during which spleen is distinguishable from otherorgans and separable from the pancreas in mice is at about day 13 ofgestation, therefore 13-, 14-15-, 16- or 17-day gestational stage mousesplenic grafts were transplanted under the kidney capsule of hostsyngeneic or allogeneic mice, and their growth and development wasanalyzed.

Experimental Results:

Syngeneic/Mouse Transplantation Model:

Identification of optimal gestational stages of splenic grafts forgeneration of normally differentiated splenic organs with no/minimalrisk of teratoma/fibrosis formation following implantation in syngeneichosts: Mouse splenic grafts at days 13, 14, 15, 16 or 17 of gestationwere transplanted into syngeneic recipients, and their development wasanalyzed histologically 6 weeks posttransplantation.

As can be seen from the results which are summarized in Table 5, graftsat days 13 or 14 of gestation formed disorganized mesenchymal tissues,however with evidence of diffuse lymphoid cell infiltration, andformation of lymphoid areas with lacunae and enlarged sinuses with redand white pulp components. In sharp contrast, tissues derived from 15-or 16-day gestational stage splenic grafts generated tissues exhibitinggood organization of both stroma and lymphoid tissue with more maturetrabecules and follicle structures, white and red like pulp areasappearing more clearly than in tissues generated by earlier stagegrafts, and occurrence of encapsulation. Occasionally, empty mesenchymalstroma structures with minimal colonization by lymphoid cells werenoted. Implantation of grafts at day 17 of gestation led to tissuesexhibiting well defined white and red pulps. In the white pulp,formation of T- and B-cell compartments was clearly demonstrated viadouble-immunostaining.

As indicated in Table 5, cystic teratoma-like structures were found inone out of seven mice implanted with a splenic graft at day 13 ofgestation. Surprisingly and in sharp contrast, 14-day gestational stagesplenic grafts generated splenic organs lacking teratoma formation,exhibiting splenic differentiation with lymphoid areas corresponding tothe white pulp in adult spleen, and exhibiting trabecules, sinus-likestructures and central arteries.

TABLE 5 Identification of optimal gestational stage of gestational stagesplenic grafts for generation of normally differentiated splenic organswith no/minimal risk of teratoma/fibrosis formation Incidence of splenicdevelopment Gesta- Incidence Incidence Incidence of tional of non-Mesen- of Incidence diffuse stage of splenic chymal lymphoid oflymphocytes graft develop- organi- follicle red pulp and (days) mentzation formation formation small clusters 13 1\7-teratoma ++ 2\7 2\7 2\72\7-fibrosis 14 2\14 fibrosis   +\ ++  2\14  8\14  9\14 15 3\10 fibrosis  ++\ +++  4\10  7\10  3\10 16   ++\ +++ 1\4 3\4 3\4 17   ++\ +++ 3\43\4 1\4 The data shown summarizes results of 11 unrelated experiments inwhich grafts between days 13 to 17 of gestation were transplanted intosyngeneic C57BL/6 or Balb/c mice. (+), chaotic stroma; (++), someorganization with few sinuses and trabecules; (+++), normal spleen-likeorganization.

Allogeneic/Mouse Transplantation Model:

Transplantation of splenic grafts at all gestational stages intoallogeneic recipient mice resulted in graft rejection with generation ofmajor fibrosis at the graft area. No signs of graft survival were seen 6weeks post-transplantation.

Characterization of splenocyte lineage population profiles during mousespleen development: The lymphoid, myeloid or mesenchymal origin ofsingle-cell suspensions of spleens from neonates, 4 week-old mice and 8week-old mice were phenotyped by FACS analysis. Antibodies used includedantibodies against CD3, CD4, CD8, CD11b, CD11c, CD29, CD44, CD49e, B220,Sca, Gr-1 and H2B. The relative levels of the different phenotypesduring spleen development is shown in Table 6.

TABLE 6 Characterization of hematopoietic lineage profiles during mousespleen maturation. Marker analyzed in Developmental stage graft-derived14-days of 15-days of 17-days of 18-days of 1 week 4 weeks 8 weekstissues gestation gestation gestation gestation Neonatal old old oldCD3 + + + ++ − ++ + CD4 − − − − + + CD8 − − − − ++ ++ B220 + + − ++ ++++++ +++++ CD11b ++ +++ +++ + + + CD11c − − +++ +++ Gr-1 ++ + + + + +H2-K^(b) +++ +++ +++++ ++++ +++++ +++++ integrin- + +++ +++++ +++++ +++++++ beta1 (CD29) Pgp-1 +++ +++++ +++++ +++++ (CD44) integrin- ++ ++++++++ ++ alpha5 (CD49e) Sca-1 − − + + +++++ +++++ (Ly6A/E) Key index:percent of total splenocytes. (−), 0-10 percent; (+), 10-20 percent;(++), 20 30 percent; (+++), 30-40 percent; (++++), 40-50 percent;(+++++), 50-100 percent.

Analysis of levels of splenocytes displaying the lymphoid-specificmarkers CD4, CD8 and B220 indicate that splenic T- and B-cellpopulations are present at basal levels until one week after birth andbegin to increase afterwards according to spleen maturation.Surprisingly, the CD3 phenotype did not correlate with the CD4 and CD8phenotypes and occurred earlier. The CD3+CD4-CD8− could represent NK Tcells or other non-T cells.

Levels of splenocytes displaying the macrophage-specific marker CD11b,or the dendritic cell-specific marker CD11c were analyzed during splenicmaturation. Macrophages were found to be present in spleen throughoutpost-gestational development, however the levels of such cells weresurprisingly found to decline during the course of spleen maturation. Insignificant contrast, levels of dendritic cells were found to increaseduring the course of spleen maturation.

Gestational stage splenic grafts have the capacity to generate splenicorgans harboring host-derived lymphoid and myeloid cells followingtransplantation into allogeneic hosts: In order to distinguishhematopoietic cells of host and donor origin within tissues generated bygestational stage splenic grafts, 14-day gestational stage grafts fromwild type C57BL/6 mice, which express the CD45 isotype Ly5.2 inhematopoietic lineage cells, were transplanted into B6SJL mouserecipients which express the CD45 isotype Ly5.1 instead. FACS analysisof tissues generated by the grafts unexpectedly showed that the growingtissue contained lymphoid cells of host origin. Therefore, it wasconcluded that such grafts give rise to splenic stromal/mesenchymaltissue capable of accommodating colonization by allogeneic hostlymphocytes. Relatively high levels of CD4+ and CD8+ lymphocytes, aswell as of B220+ B-cells, were documented in the growing graft-derivedsplenic organs. This data suggests that after 6 weeks of development thelymphoid cell constitution of the graft-derived spleen resembles that ofa normal spleen at 3-4 weeks after birth. The graft-derived tissues werealso found to harbor macrophages of host origin. In tissues generated by15-day gestational stage allogeneic splenic grafts, the cell compositionof the growing organ was similar to that generated by the 14-daygestational stage grafts, however higher levels of macrophages weredocumented.

Irradiation induces enhanced splenic maturation and hematopoiesis insplenic organs derived from gestational stage splenic graftstransplanted into allogeneic recipients: In mice, hematopoiesis occursin the spleen and is markedly enhanced following irradiation. Whileconceiving the present invention, the present inventors theorized at itmight be possible to employ irradiation to enhance hematopoiesis in thepresently described context of tissues generated by gestational stagesplenic grafts following transplantation in allogeneic recipients.However, it was unknown whether irradiation could indeed result inenhanced hematopoiesis in this novel context, and which irradiationmodality could be used to achieve such enhancement. Thus, in order toattempt to elucidate these issues, recipient mice of allogeneic 15-daygestational stage splenic grafts were subjected to varyingsub-lethal/lethal doses of total body irradiation (TBI), and the effectof such irradiation on hematopoiesis within the grafts was analyzed.300, 600 or 1000 rad total body irradiation (TBI) of graft recipientmice induced in the grafts adult-type stromal and follicular white pulporganization, and formation of trabecules, sinuses, and hematopoieticareas with megakaryocytes and granulocyte maturation. In sharp contrast,no such mature splenic structures were detected in controlnon-irradiated recipients. In addition, the size of the grafted organswas found to be larger in the irradiated as compared to thenon-irradiated hosts.

Upon 1000 rad irradiation and radioprotection with syngeneic or NOD-SCIDbone marrow, 3 out of 12 14-day gestational stage splenic graftstransplanted into allogeneic recipients generated teratoma likestructures accompanied by spleen growth.

Summary:

Transplantation of mouse 13-day gestational stage splenic grafts intoallogeneic/syngeneic hosts is capable of generating graft-derivedteratomas, whereas normal splenic development without teratoma formationwas achieved by transplantation of splenic grafts at a developmentalstage at least as advanced as 14 days of gestation. In general, in 13-to 17-day gestational stage grafts, the capacity of such grafts toexhibit splenic differentiation was found to increase with increasinggestational stage. Total body irradiation of recipients with 300 rad orhigher was found to lead to accelerated maturation and growth ofgestational stage splenic grafts. Results from experiments in theallogeneic model revealed that the hematopoietic compartment in thegrowing spleen is of host origin unlike the mesenchyme which is of donororigin.

Conclusion:

The above-described results demonstrate for the first time thatgestational stage lymphoid/hematopietic organ/tissue grafts, such assplenic grafts, have the capacity to generate growing, normallydifferentiated mesenchymal stroma in which host lymphopoiesis can takeplace lymphoid/hematopietic organs/tissue in the absence of teratomaformation following transplantation into syngeneic, or immunodeficientallogeneic recipients. The above-described results furthermore identifyfor the first time gestational stages during which such grafts optimallyhave such capacity. As such, since spleen and otherlymphoid/hematopietic organs/tissues have the capacity to producesubstances whose deficiency is associated with a disease, such as factorVIII or glucocerebrosidase deficiency in hemophilia A or Gaucherdisease, respectively, the above-described transplantation methods canbe used for optimally treating such a disease in a subject relative toknown methods.

Example 9 Porcine spleen transplantation

The following experiments were performed in order to identifygestational stages during which porcine splenic grafts followingtransplantation into xenogeneic recipients are capable of generatinggrowing, normally differentiated splenic organs with no/minimal risk ofteratoma formation and minimal immunosuppression.

Background:

Numerous highly debilitating/lethal monogenic diseases for which thereare no optimal treatment methods are associated with a deficiency in asubstance which is produced by hematopoietic/mesenchymal cells which maybe found in lymphoid/hematopietic organs/tissues such as spleen. Suchdiseases include, for example, hemophilia A or Gaucher disease which arerespectively associated with factor VIII and glucocerebrosidasedeficiency. One strategy which has been proposed to treat such diseasesinvolves transplantation of fetal xenogeneic lymphoid/hematopieticorgans/tissues which would have the great advantages of providing aessentially unlimited source of transplantable tissues, and of obviatingthe requirement for enzyme replacement therapy, the state-of-the-arttreatment method for such diseases. However, to date, it is unknownwhether and how it may be possible to optimally achieve such therapeutictransplantation in the absence of teratoma formation.

While conceiving the present invention, the present inventors discoveredthat lymphoid/hematopietic organ/tissue grafts at the appropriategestational stage has the capacity to generate growing, normallydifferentiated splenic organs with no/minimal risk of teratoma formationand minimal immunosuppression following transplantation into axenogeneic host.

The present inventors have unexpectedly determined that the optimal timewindow for transplantation of porcine fetal spleen tissue, whenconsidering all the factors i.e. functionality, organogenesis, risk ofteratoma formation and immunosuppression, is about E42 to about E56

Materials and Methods:

Real-time PCR: Graft-derived tissues were carefully dissected from thesubcapsular implantation site, and total RNA was isolated therefromusing the Tri-Reagent® method (Molecular research center, Inc.,Cincinnati, Ohio), according to the manufacturer's instructions, andtreated with RQ1 RNase-Free DNase (Promega Corp. Madison, Wis.). Thepurified RNA was reverse-transcribed into cDNA, and the cDNA was used astemplate for quantitative PCR analysis of mRNA transcripts in the graftsusing a Light Cycler instrument (Roche Diagnostics Gmbh, Mannheim,Germany), according to the manufacturer instructions, using primersspecific for porcine factor VIII [forward primer, 5′-CATGGACCTGCTTCAC-3′(SEQ ID NO: 1); reverse primer, 5′-TGACACATGATTTAATCCCG-3′ (SEQ ID NO:2)]; and for the housekeeping genes: porcine transferrin receptor[forward primer, 5′-TGTGGCAGCTCAGAAT-3′ (SEQ ID NO: 3); reverse primer,ACCGATGTGGTTACTCC-3′ (SEQ ID NO: 4)], and mouse GAPDH [forward primer,5′-CTGCGACTTCAACAGC-3′ (SEQ ID NO: 5); reverse primer,5′-GGTGCAGCGAACTTTAT-3′ (SEQ ID NO: 6)]. Quantitative PCR reactions werecarried out in triplicate for each sample, and relative quantities oftranscripts for each transplant were calculated on the basis of thecorresponding amount of porcine transferrin receptor.

Experimental Results:

Porcine 28- to 80-day gestational stage splenic grafts exhibit extensivegrowth and development of splenic structures in the absence of teratomasfollowing transplantation into immunodeficient xenogeneic recipients:Porcine splenic grafts at different gestational stages were transplantedinto NOD/SCID or CB17/ICR SCID mice to test the capacity of such graftsto generate splenic organs and teratomas following transplantation intoimmunodeficient xenogeneic recipients. A summary of the results obtainedin these experiments, describing development of the implantedgestational stage splenic grafts obtained at different gestationalstages, is given in Table 7

As can be seen in Table 7, impressive growth was achieved by 28-, 42-,56- and 80-day gestational stage grafts 6 weeks posttransplantation,with the 42- and 56-day gestational stage grafts growing to more thantwice the size of 28- and 80-day gestational stage grafts. No teratomagrowth was observed following transplantation of 28- to 80-daygestational stage porcine spleen precursors. The 28-day gestationalstage grafts displayed splenic development characterized by organizationof blood vessels and encapsulation of the graft-derived organ. Splenicorgans derived from 42- and 56-day gestational stage implants wereassociated with a more heterogeneic structure comprising loose andcondensed mesenchymal components, with the former exhibiting splenicvascularization, encapsulation, and a trabecular-like structure withlacunae likely corresponding to a sinus system lacking a lymphoidcomponent which cannot be provided by the SCID hosts. Followingtransplantation of 80-day gestational stage grafts, a differentphenotype appears characterized by well vascularized homogeneic stromawith emphasized zones of extracellular matrix, and by diffusion ofinflammatory granulocytes and macrophages throughout the graft-derivedsplenic organ. FIGS. 10 a-b show immunochemical staining with H&E andanti-vimentin (v9), respectively, of E42 transplanted porcine splenictissue 6 weeks after transplantation.

Therefore, in agreement with the above-described findings in thesyngeneic mouse model in which lymphocytes that inhabit thegraft-derived splenic organ are essentially exclusively of host origin,the splenic grafts following transplantation into SCID recipientsrepresent mostly stromal structures essentially lacking a lymphoidcomponent. The porcine origin of the stromal elements in thegraft-derived splenic organ was demonstrated by immunostaining with anantibody against porcine vimentin, which is specific for porcinemesenchyme, and colonization of the porcine graft-derived splenic stromaby xenogeneic host mouse macrophages was demonstrated by immunostainingwith an antibody for the macrophage marker F4/80 which is mouse specificand non-cross-reactive with the porcine antigen.

Splenic organs derived from gestational stage porcine splenic graftstransplanted into xenogeneic recipients produce porcine factor VIII:Considering that there are several indications in the literature thatfactor VIII, which participates in the clotting cascade, is produced inthe spleen tissue, the present inventors hypothesized that the presentlydescribed gestational stage porcine splenic grafts would be capable ofproducing useful substances, such as factor VIII, followingtransplantation into xenogeneic recipients. This would specificallydemonstrate that the presently described transplantation method could beused to produce therapeutic levels of such a substance in a graftrecipient having a disease, such as hemophilia A, which is associatedwith deficiency of a substance such as factor VIII. However, it wasunknown whether the presently described grafts would indeed be capableof secreting factor VIII following xenotransplantation.

In order to more precisely quantitate levels of porcine factor VIIIexpression, precursors of porcine tissues and graft-derived tissues wereanalyzed via real-time RT-PCR assay. As can be seen in FIG. 11,expression of porcine factor VIII mRNA in the liver and spleen increasesduring gestation. Moreover, porcine spleens derived from adult or fromembryonic E80 or E100 express high levels of porcine factor VIII mRNA,although slightly lower than the levels expressed by porcine liverderived from the same gestational stages, respectively. FIG. 11 showsthe relative amounts of porcine factor VIII mRNA in different tissuesbefore and after transplantation were evaluated by Real-time PCR usingprimers specific for porcine factor VIII. The results were divided bythe expression of the house-keeping gene Beta-actin, using primersspecific for the porcine Beta-actin. Total mRNA that was purified eitherfrom adult tissue or from E80 or E100 precursor tissue from porcineliver and porcine spleen served as positive control. Total mRNA that waspurified from the mouse kidney, from an area distant from the embryonicimplant, served as negative control.

Six weeks after transplantation of embryonic spleen tissue from E28,E42, E56 into immunodeficient mice, the spleen grafts exhibitedsignificant levels of porcine factor VIII mRNA expression. In contrast,control gestational stage pancreatic and pulmonary grafts generatedtissues which either did not express or exhibited markedly reducedlevels of factor VIII mRNA, respectively. Such low levels of porcinefactor VIII mRNA expression observed in tissues derived from thepulmonary grafts is likely due to the dense blood vessel network whichwas formed in such tissues.

Summary:

In agreement with the results in the allogeneic mouse transplantationmodel described above, porcine gestational stage splenic graftsimplanted in SCID mice generated splenic organs characterized bymesenchymal growth and development in the absence of a lymphoidcomponent. Transplantation of porcine 28- to 80-day gestational stagesplenic grafts generated graft-derived splenic organs exhibiting similarhistological organization in the absence of teratomas, with optimalgrowth and development and low host immune response being achieved using42 and 56-day gestational stage implants. The splenic organs derivedfrom gestational stage porcine splenic grafts exhibited significantlevels of factor VIII mRNA expression, as defined by RT-PCR analysis.

Conclusion:

The above-described results demonstrate for the first time thatgestational stage porcine lymphoid/hematopietic organ/tissue grafts,such as porcine fetal splenic grafts, have the capacity to generategrowing, normally differentiated lymphoid/hematopietic organs/tissues inthe absence of teratoma formation following transplantation intoxenogeneic recipients. The above-described results furthermore identifyfor the first time gestational stages during which such grafts optimallyhave such capacity. As such, since such porcine grafts are available inessentially unlimited quantities, and since lymphoid/hematopieticorgans/tissues have the capacity to produce substances whose deficiencyis associated with a disease, such as factor VIII or glucocerebrosidasedeficiency in hemophilia A or Gaucher disease, respectively, theabove-described transplantation methods are clearly superior to knownmethods of treating such a disease in a subject.

TABLE 7 Porcine E28- to E80-day gestational stage splenic grafts havethe capacity to generate, with no/minimal risk of teratoma formation,extensively growing, normally differentiated splenic organs followingtransplantation into immunodeficient xenogeneic recipients GestationalFraction of grafts Graft growth stage of displaying splenic (squaremillimeters, grafts (days) differentiation* average ± standarddeviation) 28 14/17 30.6 ± 10.5 42  6/10  76 ± 9.9 56 4/5 70.6 ± 9    804/5 27 ± 19 *None of the grafts were observed to generate teratomasfollowing transplantation. Grafts were analyzed 6 weeksposttransplantation.

Example 10 Hemophilia a Treatment Via Transplantation of DevelopingXenogeneic Spleen

Abstract

Previous clinical attempts to correct genetic deficiencies such ashemophilia A or Gaucher by transplantation of allogeneic spleen wereunsuccessful, and were associated with aggressive graft versus hostdisease (GVHD), mediated by mature T cells in the donor spleen. In thepresent studies it is disclosed that fetal pig spleen harvested at theE42 stage, prior to appearance of T cells, exhibited optimal growthpotential upon implantation into SCID mice, and the growing mesenchymaltissue expressed factor VIII mRNA Implantation of E42 spleen precursortissue into hemophilic SCID mice led to complete alleviation ofhemophilia A within 3 months posttransplant, as demonstrated by tailbleeding, and by assays for Factor VIII blood levels. These resultsprovide a proof of principle for the concept that implantation ofembryonic spleen precursor tissue obtained prior to the appearance of Tcells, could provide a novel treatment modality in hemophilia A and inother genetic deficiencies of an enzyme or a factor that can be producedby the growing spleen tissue.

Introduction:

Inherited genetic diseases represent natural targets for gene therapy,but considerable difficulties arise in targeting gene delivery tospecific cell types in vivo, regulating the expression of recombinantgenes, and controlling vector immunogenicity (1).

Inherited hemophilia A is thought to be a particularly promising genetherapy target, because the deficient protein (factor VIII) circulatessystemically and can be synthesized, in theory, by various cell types.Indeed, preliminary trials have demonstrated expression of human factorVIII in animals and in patients following gene transfer (2-4). Inparallel, progress in transplantation over the past decade, encouragedthe consideration of cell or organ transplantation as a potentialtreatment for genetic diseases, such as hemophilia A.

The liver is considered to be the primary source of factor VIII protein.Hepatocytes and liver sinusoidal endothelial cells, but not Kupffercells, produce factor VIII in the mouse liver (5). The role of the liverin factor VIII synthesis has been supported by liver transplantationstudies in both hemophilic animals and humans, following which,increasing factor VIII levels were detected (6-8). Transplantationstudies in hemophilic animals showed that organs such as spleen and lungalso contribute to the presence of circulating factor VIII (9, 10).

The feasibility of spleen transplantation in the treatment of hemophiliaA in humans was first documented in 1969 by Hathaway, who transplanted aspleen donated by a family member (11). The recipient displayed a markedrise in factor VIII shortly after the transplant, but the spleen grafthad to be removed 4 days later due to severe rejection.

Subsequently, a number of spleen transplants (living donor or cadaveric)in hemophilic patients have been reported. At least one resulted insustained, normalized levels of factor VIII with stable factor VIIIproduction for 5 months after operation (12, 13). Little data areavailable regarding spleen transplantation in the treatment of othergenetic diseases but there are several case reports in the literaturesuggesting the potential of spleen transplantation as a treatment forGauche disease and hypogammaglobulinemia (13-15).

A major obstacle in spleen transplantation is associated with graftversus host disease (GVHD) mediated by donor T cells present in thespleen graft. In principle, this potentially lethal complication may beprevented if it were possible to use embryonic precursor spleen tissueobtained prior to the appearance of mature T cells in the spleen.

Considering the recent interest in fetal tissue as a source fortransplantation, it is surprising that the role of embryonic spleentissue as a source for secreted proteins has never been studied.Clearly, if early embryonic spleen tissue will prove feasible, it couldbe of particular importance, as this precursor tissue is devoid of Tcells which are known to mediate GVHD typical of adult spleentransplantation.

In the present study, the potential of pig embryonic spleen tissue as anovel tissue source for transplantation was examined for the first time,with emphasis on relatively early gestational time points at whichmature T cells are not found in the implant. The proof of concept,namely the ability to correct hemophilia A using early embryonic spleentissue, was then demonstrated in factor VIII knock-out hemophilic SCIDmice.

Materials and Methods:

Animals:

Animals were maintained under conditions approved by the InstitutionalAnimal Care and Use Committee at the Weizmann Institute. A breeding pairof factor VIII KO mice was purchased from Jackson laboratory (strainname: B6; 129S4-F8tm1Kaz/J, stock number: 004424)

To obtain immunodeficient hemophilic mice (designated as factor VIIIKO-SCID), FVIII-deficient mice were crossed with SCID mice. Genotypingand phenotypic characterization of the FVIIIKO and factor VIII KO-SCIDoffspring were performed confirming that all FVIII-deficient mice usedin this study are factor VIII KO-SCID mice.

Immune deficient NOD-SCID or factor VIII KO-SCID mice (WeizmannInstitute Animal Breeding Center, Rehovot, Israel) were used as hostsfor the transplantation studies at the age of 8-10 weeks. All mice werekept in small cages (up to five animals in each cage) and fed sterilefood and acid water containing ciprofloxacin (20 mg/ml).

Pig embryos were obtained from the Lahav Institute of Animal Research,Kibbutz Lahav, Israel. Pregnant sows were operated on at specific stagesof the pregnancy (E24, E28, E42, E56, E80, and E100) under generalanesthesia. Warm ischemia time was less than 10 minutes and the embryoswere transferred to cold PBS. Spleen precursors for transplantation wereextracted under a light microscope and were kept in sterile conditionsat 40 degrees centigrade in RPMI 1640 (Biological Industries, BeitHaEmek, Israel) before transplantation. Cold ischemia time untiltransplantation was less than 2 hours. The study protocol was approvedby the ethics committees at Kibbutz Lahav and the Weizmann Institute.

Transplantation Procedure:

Transplantations of the embryonic precursors were performed undergeneral anesthesia (2.5 percent 2,2,2-Tribromoethanol, 97 percent inPBS, 10 ml/kg intraperitoneally). Host kidney was exposed through a leftlateral incision. A 1.5-mm incision was made at the caudal end of thekidney capsule and donor precursors were grafted under the kidneycapsule in fragments 1-2 mm in diameter.

Morphometric Analysis:

Specimens of pig embryo spleen, 6 weeks following transplantation, atdifferent gestational ages (from E-28 to E-100) were formalin fixed andembedded in paraffin. Consecutive sections were cut and stained. Thedistance between sections was 40 microns. The areas of interest werequantified using the Image Pro program (Media Cybernetics).

Immunohistochemistry:

For immunohistochemical labeling, the following antibodies were used:mouse anti vimentin (clone V9) (Dako, DakoCytomation Denmark), mouseanti-human Ki67 (clone MIB-1) (Dako), rabbit anti human CD3 (Dako),mouse anti porcine CD31 (Serotec, Enco Scientific Services Ltd Israel),rabbit anti-Laminin (SIGMA-ALDRICH, Israel), rat anti mouse CD11b (Mac-1antigen, clone M1/70) (BD Pharmingen, BD biosciences) and rat anti mouseTER-119 (BD Pharmingen).

Paraffin sections (4 microns) were xylene deparaffinized and rehydrated.Endogenous peroxidase was blocked with 0.3 percent hydrogen peroxide in70 percent methanol for 10 minutes. Antigen retrieval procedures wereperformed by micro gal coking at pH 6 or enzymatic pretreatmentaccording to the manufacturer's instructions.

After blocking, both paraffin sections and 6 micron cryosections wereincubated with specific first antibody for 60 minutes. Detection ofantibody binding was performed using Dako peroxidase Envision System fordetection of mouse and rabbit antibodies. In both cases,diaminobenzidine (DAP) was used as a chromogen.

Real-Time PCR:

Grafts were dissected carefully from the subcapsular site andhomogenized in Tri-reagent. Total RNA was isolated using the Tri-reagentmethod according to the manufacturer's instructions (Molecular ResearchCenter, Inc., Cincinnati, Ohio). Purified RNA was treated with RQ1RNase-Free DNase (Promega Corp. Madison, Wis.), then reverse transcribedinto cDNA, and amplified using the Light Cycler quantitative PCR usingprimers specific for pig factor VIII and the housekeeping genes, pigtransferrin receptor and mouse GAPDH.

Quantitative PCR reactions were carried out using triplicates of eachsample using the Light Cycler reaction as instructed by the manufacturer(Roche Diagnostics Gmbh, Mannheim, Germany). The relative amount ofproduct in each transplant was normalized to the level of pigtransferrin receptor.

Primers used for pig factor VIII were: forward-CATGGACCTGCTTCAC;reverse-TGACACATGATTTAATCCCG (SEQ ID NO: 2). Primers used for pigtransferrin receptor were: forward-TGTGGCAGCTCAGAAT (SEQ ID NO: 3);reverse-ACCGATGTGGTTACTCC (SEQ ID NO: 4). To show specificity of theseprimers, primers specific for mouse GAPDH were also used:forward-CTGCGACTTCAACAGC (SEQ ID NO: 5); reverse-GGTGCAGCGAACTTTAT (SEQID NO: 6).

Plasma Factor VIII Assays:

Factor VIII activity was assayed in citrated plasma collected fromrecipients. PTT was determined with a coagulometer Sysmex CA-6000(Assays were performed in the clinical hematology lab; Kaplan MedicalCenter, Rehovot). The chromogenic activity assay, which measures theFVIII dependent generation of FXa from FX (COATEST FVIII: Chromogenix,Molndal, Sweden), was performed.

Tail Clipping:

Tail clipping (approximately 1.5 cm from tip) was performed withoutsubsequent cauterization to measure bleeding propensity. After theprocedure, mice were checked every 4 hours. The proportion of survivingmice at 24 hours after the procedure was recorded.

Statistical Analysis:

Comparisons between groups were evaluated by the Student's t-test. Datawere expressed as mean±SD, and were considered statistically significantat p values of 0.05 or less.

Experimental Results:

The gestational time window enabling the harvest of human and pigembryonic kidney precursor tissue for growing functional small kidneysin SCID mice has previously been established (16). More recently,similar ‘windows’ for pig embryonic pancreas, liver and lung weredefined (17). In the present study, spleen embryonic tissue washarvested at different gestational time points and stained for CD3positive cells to determine the precise period of time in pig ontogenyat which mature T cells are first present in these tissues. As can beseen in FIGS. 12 a-e, T cells were initially detectable in the tissueobtained at the E56 gestational age.

Thus, in order to avoid GVHD, harvest of pig spleen tissue fortransplant should be limited to E42 or earlier time points. To definethe earliest gestational time point at which the maximal growthpotential of transplanted tissue is exhibited, pig embryonic spleentissues obtained at different stages, ranging from E28 to E100, wereimplanted into NOD/SCID mice, and 6 weeks later the implant's size, aswell as its differentiation, were evaluated by computerized morphometricanalysis. Consecutive sections were cut at 40 micron intervals andstained for vimentin (clone V9, which decorates pig but not mousemesenchymal tissue), Ki67 (proliferation marker), and pig CD31(endothelial cell marker); thereafter, using the Image Pro program, thetotal graft volume and fraction volumes of mesenchymal compartments weredetermined. As can be seen in Table 8, summarizing the results of themorphometric analysis, the largest implant volume was found followingtransplantation of tissue obtained at E42. The growth was significantlyaccelerated compared with implants obtained at earlier (E28) or later(E56, E80 and E100) gestational time points, suggesting unique growthpotential of spleen precursors at particular time points duringgestation.

TABLE 8 Morphometric analysis of pig splenic precursors GestationalImplant volume Vimentin volume Vimentin age (mm3) (mm3) (percent ofvolume) E28   4.9 ± 0.99  2.34 ± 0.454 47.8 E42  21.94 ± 4.95  10.275 ±2.736  46.8 E56  10.49 ± 5.01  3.146 ± 1.419 30.0 E80  5.82 ± 5.92 1.131± 0.063 19.4 E100 0.088 ± 0.01  0.011 ± 0.006 12.2

A macroscopic image of the implant growing 6 weeks after transplantationof E42 pig spleen tissue is shown in FIG. 13 a. The pig origin of thestromal component was demonstrated by vimentin immunolabeling (FIG. 13b). These stromal cells are supported by pig blood vessels stained byanti-CD31 (FIG. 13 c) (non-cross reactive with mouse CD31) and arehighly proliferative, as demonstrated by high levels of Ki67 labeling(FIG. 13 d).

Histological evaluation of the growing E42 spleen tissue at differenttime points revealed unorganized early stage in the formation of thehematopoietic compartment at 2 months posttransplant. Gradually, nestsof hematopoietic red pulp-like splenic tissue are formed at month 3(FIG. 14).

Immunostaining of Mac1 antigen expressed on mouse myeloid cells and withanti-Terr1 specific for the mouse erythroid cells, demonstrate that thepig stroma is gradually populated with host type myelopoiesis anderythropoiesis, as is typically found in the adult mouse spleen.However, mouse lymphopoiesis is not observed due to the SCID mutation ofthe implant recipients.

Similar patterns of hematopoietic nests, separated by connective tissuesepta, were observed 5 months after transplantation. In these nests,hematopoietic cells were observed adjacent to loosely distributedmesenchymal stromal elements (data not shown). Thus, the E42 spleentissue gradually assumes its hematopoietic character without any signsof aberrant differentiation typical of tumors and, in particular, ofteratomas.

Taken together, these results suggest that of the early gestationalstages devoid of T cells, E42 exhibits optimal growth potential andcould, therefore, afford a suitable source for transplantation tocorrect hemophilia A or other genetic deficiencies.

Correction of Hemophilia A by E42 Pig Spleen Tissue:

Based on several indications in the literature that factor VIII isproduced in the spleen of adult tissue (11-13), attempts were made tomeasure the expression of pig factor VIII in the implants growing fromembryonic spleen tissue obtained at different time points. Since noporcine specific anti-factor VIII antibodies are available, tissue mRNAexpression in the growing embryonic spleen mesenchyme in comparison toimplants of pig embryonic pancreas was initially evaluated. Pig specificprimers for factor VIII were developed and used to screen the growingimplants. This analysis confirmed pig factor VIII mRNA expression in thespleen stroma derived from embryonic porcine E28 to E56 gestational agetissue, implanted into SCID mice (data not shown).

In order to more precisely determine the levels of porcine factor VIIIexpression in implants of pig embryonic spleen, graft-derived tissueswere analyzed by RT-PCR. As can be seen in FIG. 15, 6 weeks aftertransplantation of E28, E42 or E56 spleen tissue, the grafts exhibitedmarked levels of porcine factor VIII mRNA expression, while pancreatictissue growing out of embryonic pancreas precursor tissue did notexhibit an appreciable expression of factor VIII mRNA.

To ascertain the functionality of the transplanted tissue in factor VIIIproduction, attempts were made to treat factor VIII KO mice (B6-129background) by implantation of E42 pig spleen tissue. However, as therecipient KO mice have a relatively normal immune system, theimplantation of pig tissue required continuous immune suppressioninvolving intra-peritoneal injection of immunosuppressive drugs, aprocedure that caused marked bleeding and high death rate due to thehemophilic status of the recipients (not shown). (Immunosuppression isanticipated to be technically easier in humans, as described below).Therefore, in order to circumvent the need for continuous injection ofimmune suppressive agents, a strain of VIII KO-SCID mice (18) was usedto further analyze the potential of E42 spleen tissue to correcthemophilia A. Indeed, implantation in these mice, performed under shortterm treatment with soluble factor VIII to enable the animals totolerate the surgical procedure, was not associated with high mortality,and the mice were able to withstand repeated testing for factor VIIIactivity.

Traditionally, a clotting assay measuring partial thromboplastin time(PTT) is used for testing factor VIII activity. In addition, theindirect Coatest chromogenic assay offers a more sensitive determinationof the presence of factor VIII by measuring its activity on cleavage ofFactor X.

As can be seen in FIG. 16, recipients of E42 spleen tissue exhibitednormalized PTT levels by 3-4 months posttransplant. Thus, whileuntreated factor VIII KO-SCID mice or those at 2 weeks posttransplantexhibited PTT levels of 43.06±1.07 sec and 39.63±5.12 sec, respectively,the mice implanted with E42 spleen exhibited at 12 weeksposttransplantation markedly reduced PTT values (23.8±3.94 sec,P=0.001), comparable to the levels found in control, non-hemophilic SCIDmice (22.12±1.14 sec, P=0.001).

Likewise, factor VIII blood level determined by the Coatest assay (FIG.17 a-b) revealed significantly elevated levels in the blood oftransplanted mice at 14 weeks posttransplantation (63.4±49.6 percent ofnormal levels) compared to the levels found in factor VIII KO-SCID mice(zero values) and in non-hemophilic SCID mice (102±31.2 percent).Considering that severe, moderate and mild hemophilic states, defined bypercentage of factor VIII are below 1, 4 and 6 percent, respectively, itis significant that the levels in the entire group of transplanted miceranged above these amounts (between 7 to 100 percent of factor VIIIactivity)

Finally, when exposed to tail clipping, 7 out of 7 implanted micesurvived, while almost all the non-implanted control mice died ofbleeding within 24 hours (Table 9).

TABLE 9 Survival following tail clipping. Mouse strain TreatmentSurvival frequency SCID None 5/5 SCID E42 spleen transplantation 3/3Factor VIII KO-SCID None  1/13 Factor VIII KO-SCID E42 spleentransplantation 7/7

Discussion:

Taken together, the presently disclosed results show for the first timethe feasibility of using embryonic spleen tissue, prior to theappearance of T cells in the tissue, for the correction of a geneticdeficiency.

Hemophilia A is a bleeding disease caused by factor VIII deficiency.Factor VIII replacement therapy can reduce bleeding but is expensive,inconvenient, and often complicated by development of antibodies thatinhibit factor VIII activity in 30 percent of patients. Clearly, a novelalternative source of factor VIII, such as embryonic spleen tissue,might open new treatment modalities which could provide long termbenefit to hemophilia A patients.

A major obstacle to the implementation of embryonic allo- orxenotransplantation in patients is related to its potentialimmunogenicity. Thus, the issue of immune suppression is critical, andfurther studies in large animal models are required to define whetherlong term immune tolerance towards the implanted embryonic spleen can beinduced with minimal toxicity. Numerous studies over the past fourdecades have suggested that embryonic tissues are less prone to immunerejection (19-22). Nevertheless, exactly how much and for how long,immune suppression will be required to allow engraftment of fetal spleentissue will determine its applicability to treating monogenic inheriteddiseases. Preliminary results suggest that E42 pig spleen is far lessimmunogenic compared to fetal spleen tissue obtained at later timepoints or compared to adult spleen (not shown), and furthermore,implantation in immunocompetent mice suggests that rejection can beprevented by co-stimulatory blockade, known to also effectively inhibitantibody production. Thus, it might be possible, in the future toaddress the issue of anti-factor VIII inhibitory antibodies bystrategies combining neonatal transplantation of fetal spleen with shortterm co-stimulatory blockade or other mild tolerance-inducingmodalities. However, considering that such approaches will be associatedwith some risks, it is envisioned that fetal spleen transplantation willbe most suitable in diseases for which no therapy is currentlyavailable. Although it is presently demonstrated as proof of principlethat transplantation of fetal spleen can ameliorate genetic deficienciesin hemophilic mice, the clinical evaluation of this approach will beinitially justified in other diseases such as phenylketonuria (PKU) orornithine transcarbamylase (OTC) deficiency, for which replacementtherapy with an exogenous enzyme or factor is not available.

A second major issue that must be addressed in further studies isrelated to the choice of fetal tissue. As a proof of principle, thepotential of pig embryonic tissue was evaluated. Several safetyconcerns, in particular the potential hazards associated with endogenousretroviruses (PERV), have presented major obstacles for this application(23-25). However, it is important to note that previous pig-to-humanxenotransplantations have failed to reveal even a single instance ofPERV transmission to a human subject (26). Moreover, a recent study hassuggested that PERV could be eradicated from pig herds bred forxenotransplantation (27). Thus, as suggested recently by Ogata and Platt(28), although the potential danger of PERV to public health cannot beentirely dismissed, it should be approached with careful attention tothe xenograft recipients, rather than necessitating thatxenotransplantation studies be abandoned. However, pig embryonic tissue,while circumventing ethical issues associated with human embryonic stemcells or tissues might be more prone to rejection compared to humanfetal spleen tissue.

Thus, the use of human fetal spleen tissue from early abortions, ifdeemed ethically acceptable, represents a potentially superior tissuesource. Optimal gestational time for harvesting human spleen tissue iscurrently under investigation in SCID mice.

In conclusion, regardless of the immune suppression modalities whichwill be required and must be defined in large animal models, thepresently disclosed data provide a proof of concept for the curativepotential of T cell free, embryonic spleen tissue as a novel source fortransplantation in patients with genetic deficiencies.

It is appreciated that certain features of the invention, which are, forclarity, described in the context of separate embodiments, may also beprovided in combination in a single embodiment. Conversely, variousfeatures of the invention, which are, for brevity, described in thecontext of a single embodiment, may also be provided separately or inany suitable subcombination.

Although the invention has been described in conjunction with specificembodiments thereof, it is evident that many alternatives, modificationsand variations will be apparent to those skilled in the art.Accordingly, it is intended to embrace all such alternatives,modifications and variations that fall within the spirit and broad scopeof the appended claims. All publications, patents, and patentapplications mentioned in this specification are herein incorporated intheir entirety by reference into the specification, to the same extentas if each individual publication, patent, or patent application wasspecifically and individually indicated to be incorporated herein byreference. In addition, citation or identification of any reference inthis application shall not be construed as an admission that suchreference is available as prior art to the present invention.

REFERENCES CITED Additional References are Cited in the Text

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What is claimed is:
 1. A method of providing a pancreatic function to asubject in need thereof, the method comprising transplanting into thesubject a human pancreatic vascularized organ/tissue graft, wherein saidhuman pancreatic vascularized organ/tissue graft is at a developmentalstage of about 14 to about 20 weeks of gestation, thereby generating afunctional pancreatic organ/tissue for providing the pancreatic functionto the subject.
 2. The method of claim 1, wherein said pancreaticvascularized organ/tissue graft is non-syngeneic with the subject. 3.The method of claim 1, wherein the subject is human.
 4. The method ofclaim 1, wherein the subject has an abnormal activity of a biomoleculenaturally produced by a mammalian pancreas.
 5. The method of claim 1,wherein the subject has an abnormal activity of a biomolecule naturallyproduced by a mammalian pancreatic islet.
 6. The method of claim 5,wherein said biomolecule is insulin.
 7. The method of claim 1, furthercomprising transiently administering to the subject at least one T-cellcostimulation inhibitor and at least one CD40 ligand inhibitor.
 8. Themethod of claim 1, wherein said transplanting said graft into thesubject is effected by transplanting said graft under at least one renalcapsule of the subject.
 9. The method of claim 1, wherein saidtransplanting said graft into the subject is effected into a siteselected from the group consisting of the portal vein, the liver, thepancreas, the testicular fat, the sub-cutis, the omentum, an intestinalloop and the intra-abdominal space.
 10. A method of generating pulmonarytissue in a mammalian subject in need thereof, the method comprisingtransplanting into the subject a developing mammalian pulmonary graft,wherein said pulmonary graft is at a developmental stage essentiallycorresponding to that of a porcine pulmonary organ/tissue at agestational stage selected from a range of about 42 to about 80 days ofgestation, thereby generating pulmonary tissue in the subject.
 11. Themethod of claim 10, wherein said pulmonary graft is at a developmentalstage essentially corresponding to that of a porcine pulmonaryorgan/tissue at a gestational stage selected from a range of about 56 toabout 80 days of gestation.
 12. The method of claim 10, wherein saidpulmonary graft is a human pulmonary graft.
 13. The method of claim 12,wherein said human pulmonary graft is at a developmental stage of about14 to about 28 weeks of gestation.
 14. The method of claim 12, whereinsaid human pulmonary graft is at a developmental stage of about 19 toabout 28 weeks of gestation.
 15. The method of claim 10, wherein saidpulmonary graft is non-syngeneic with the subject.
 16. The method ofclaim 10, wherein the subject is human.
 17. The method of claim 10,further comprising transiently administering to the subject at least oneT-cell costimulation inhibitor and at least one CD40 ligand inhibitor.18. The method of claim 10, wherein the subject has a pulmonary disease.19. The method of claim 18, wherein said pulmonary disease is selectedfrom the group consisting of cystic fibrosis, emphysema, asbestosis,chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis. 20.The method of claim 10, wherein said transplanting said graft into thesubject is effected by transplanting said graft under at least one renalcapsule of the subject.